The goal of any Environmental Services Department within a healthcare facility should be to prevent the spread of infectious agents among patients and healthcare workers by meticulous cleaning and appropriate disinfection of environmental surfaces. To reach this goal, the EVS department will need to have a comprehensive training program, the objective of which should be to provide department staff with the information they need to accomplish their jobs safely. The training program should be a part of the big picture of “How to Protect Yourself.” At a minimum the training program should include the following:

1. Identification of occupational risks and hazards associated with handling infectious waste.
2. Sharps safety.
3. Blood borne pathogens.
4. Infection control training – (a) Microbiology and (b) Transmission.
5. Hand hygiene.
6. Personal Protective Equipment (PPE) including donning and doffing.
7. MSDS and hazards associated with using chemicals (cleaning agents, disinfectants, etc.)
8. Product usage training including proper cleaning and disinfection techniques.

The benefit behind breaking the training into sections is two-fold. First, it allows the person responsible for training to involve other departments such as Infection Control or Occupational Health & Safety where specific knowledge and expertise can be called upon. Second, by segmenting the areas into shorter pieces the trainee is not overwhelmed. The individual sections also allow for developing unique methods of delivery. Education should be tailored to the size, topic and needs of the group. Not all programs must be instructor-led in classroom setting. They can also consist of CD programs and/or video-based programs or a series of self-study modules. For example, the product usage training may be better suited to a traditional classroom setting where employees can observe someone performing the task while other sections such as Blood Borne Pathogens can use video-based training. Switching up the method of delivery helps keep the trainee engaged.

A basic understanding of these eight topics doesn’t require a stethoscope or coke-bottle glasses, or even the ability to squint. It takes knowledge, imagination and responsibility. Knowledge… to know basic microbiology, where pathogenic microbes are found, and how they cause disease; to know how cleaning and disinfectant products should be used; to know how to be protected from exposure to blood borne pathogens and sharps injuries; about the proper use of PPE. Imagination… to be able to actually picture the microbes all around us. Responsibility… to take reasonable action to prevent disease.

One person dies every six minutes from hospital-acquired infection. It’s tragic that this is allowed to continue and that an Environmental Services department can be allowed to operate without ongoing, targeted and evolving education.

Time spent properly training staff is an investment that pays dividends for a long time. Training should be a constant process, not just something you do for new employees or to meet the annual requirement. Whenever new products, equipment or procedures are introduced into your department, all staff should be trained on their safe and proper use. Research has shown that adults learn differently than children do, they generally learn more and retain more if they are involved in the training process. Adults learn best by doing, not by listening to lectures or by viewing videos. Lectures and videos have a place in the training process, but trainee involvement needs to be included.

Feel free to share your thoughts and comments.

Download the Environmental-Cleaning-Checklist-10-6-2010 from this link or go directly to the CDC site.

In the great work presented in Options for Evaluating Environmental Cleaning, December 2010 by Alice Guh, MD, MPH and Philip Carling, MD, objective monitoring of environmental surfaces was studied and presented as a necessary component of training. In view of the evidence that transmission of many healthcare acquired pathogens (HAPs) is related to contamination of near-patient surfaces and equipment, all hospitals are encouraged to develop programs to optimize the thoroughness of high touch surface cleaning as part of terminal room cleaning at the time of discharge or transfer of patients. A two level approach to this is presented and quite well discussed.

For now please draw your attention to the 8 locations above. The importance of targeted cleaning to these surfaces must be taught to your staff and reinforced on a regular basis. While many of our staff have an excellent understanding of the basic policies and procedures involved in terminal room cleaning, most will benefit from focused educational interventions related to our evolving understanding of the role of the environment in healthcare-associated pathogen (HAP) transmission. Specific targeted cleaning will not only reduce HAI’s it will greatly increase the awareness level of your staff.

Equipment

Goggles or safety glasses

Microfiber dust mop and wet mop handle with pad holders and buddy jug

Microfiber dust and wet mop heads

Microfiber cleaning towels

Nylon broom and dustpan

Scotch Brite blue power pad scrubbing pads

Toilet bowl mop and caddy

Putty knife

Small detail brush

Assignment checklist and pen

Personalized environmental services calling card “Clean as a whistle”

Wet floor signs

Vacuum cleaner

Chemicals

EPA registered hospital grade cleaner disinfectant: Virex II 256 (#5)

Oxivir TB, ready to use EPA registered hospital grade cleaner disinfectant

Glance glass and multi surface cleaner (#1)

Emerel multi surface crème cleanser

Misty lemon oil furniture and stainless steel polish

Stride neutral cleaner (#18)

Consumables

Toilet seat covers

Paper towels

Hand soap

Alcohol based hand sanitizer

Large and small trash liners

Disposable non latex gloves (on the cart)

Cleaning procedures are performed with a germicidal detergent which is designed to kill the most common kinds of harmful bacteria. This solution does not kill all of the bacteria, but reduces them to a safe level. The only way to kill all bacteria is to apply a very high temperature for long periods of time such as done in an autoclave.

Since many bacteria ride from place to place on dust particles, cleaning procedures are designed to prevent scattering of dust; therefore, damp-dusting and treated dust-mops are effective. Straw brooms for sweeping or feather dusters would scatter bacteria and are not used in healthcare facilities.

There are certain kinds of harmful bacteria that the germicide does not kill, but these are reduced to a safe level if proper procedures are used. The cleaning process is mainly a transfer of bacteria from one place to another. Bacteria are transferred from the surface being cleaned to your mop-head or micro fiber towel.

It is important to use solutions properly. Too much soap will leave a sticky residue or film, while too little will not clean properly. Always use your chemical dispenser and never mix chemicals yourself.

Always pick up trash inside the room to prevent bacteria from spreading to other areas. Covers should always be kept on trash barrels of cleaning carts.

6. Mattresses: Clean, free of stains and lint; should be germicidal cleaned on both sides.

7. Bedside Tables: Tabletop shelves, inside door facings and hinges clean, free of dust and lint. Legs and wheels free of dust, dirt, lint, hair or other debris.

8. Overbed Tables: Clean, free of dust. Tabletop is free of stains, streaks, spots, dirt and liquid residue. The mirrors are clean, free of streaks and spots. Wheels free of dust, hair or other debris.

9. Closets: Clean and free of dust and lint. All drawers in bedside shelf units free of dust, dirt, and lint. All handles on drawers germicidal damp wiped.

10. Chairs: Germicidal damp wiped. Free of lint, dust, and spots. Legs free of mop splatters.

11. Television Sets: Clean, free of dust and lint on screen, top, and sides.

12. Blinds: Clean, free of lint, dust, and dirt on both sides of blind slats. Blind adjusters germicidal damp wiped daily.

13. Overbed Light & Cord: Completely free of dust, dirt, and lint. Light pull cord germicidal damp wiped daily.

14. Telephones: Clean, free of dust and lint; total receiver germicidal damp wiped daily. Cord is wiped daily, and free of dust and dirt accumulations.

15. A/C Units: Vents clean, free of dust and lint. Sill area germicidal damp wiped daily; corners free of soil accumulations.

16. Windows: Completely clean, free of any streaks, spots, adhesive, or lint. Windows free of smears or haziness.

17. Paper Towel Soap Dispensers: Free of dust, lint, spots, and streaks on top and sides. Supplies properly replenished so as not to cause waste.

18. Walls & Partitions: Clean, free of dust, dirt, and soil residue; no spots or stains left on walls. Free of finger marks around light switches. No dust on top of partitions. Spot clean daily.

19. Doors: Clean, free of spots, marks, and stains. Kick plates are clean and free of wax splatters or scuff marks. Top of door is free of dust and dirt. Door handle, push plate, or doorknob clean and germicidal damp wiped daily. Door frame and hinge areas clean of dust and dirt.

20. Floors: Clean completely free of dust, lint, and stains; no wax build-up or accumulation of dirt in corners or between edge of flooring and bottom of base coving. Completely free of all scuffs and heel marks. Free of spots, spills, and tracking. Free of discolored or old floor finish. Carpet is free of spots and vacuumed thoroughly.

21. Base Covings: Clean, free of dust, dirt, and soil residue. No mop water splatters; no soil accumulation in corners. No wax build-up on coving.

22. Cubicle Curtains: Clean and free of stains, spots, or any type of residue. Curtains should pull freely around bed and hanging properly.

23. Water Fountains: Stainless steel free of water spots and streaks. Lime residue removed from basin and mouthpiece daily, rinsed thoroughly. Handles germicidal cleaned and rinsed daily.

24. Desks: Clean, free of accumulated dust. No furniture polish build-up on desktops. Sides of desks and legs of desks wiped daily.

25. Bookcases: Clean, free of dust accumulation; no furniture polish build-up on bookcase tops. Sides of bookcases wiped down weekly.

The above stated quality standards are guidelines to give the employee a reference for understanding what level of cleanliness is expected. Employees will be held responsible only for those items that are within their specified areas of assignment or job responsibility.

For example, the technician will not be held responsible for yellowed or discolored floor finish or wax build-up in the room, but would be held responsible for any spots or spills on the floor, the types of things that are removable normal cleaning procedures.

During quality control room inspections, consideration will be made concerning things that the employee has the ability to clean or improve, and those things that can not be cleaned or improved by the technician will not be held against them. We do expect that you will submit a work order if the floor needs to be refinished or the carpet cleaned.

• Scrubbing is the best way to physically remove dirt, debris and microorganisms.
• Cleaning is required prior to any disinfection process because dirt and debris will decrease the effectiveness of disinfectants.
• Cleaning products should be selected on the basis of their use, efficacy, safety and cost.
• Cleaning should always progress from the least soiled areas to the most soiled areas and from high to low areas, so the the dirtiest areas and debris that falls will be cleaned up last.
• Dry sweeping, mopping and dusting should be avoided to prevent dust and microorganisms from getting into the air and landing on clean surfaces.
• Mixing and dilution instructions must be followed. Too much or too little will reduce the effectiveness of cleaners and disinfectants.
• Cleaning methods and written cleaning schedules (work routines) should be based on the type of surface, amount and type of soil present and the purpose of the area.
• Routine cleaning is necessary to maintain a standard of cleanliness. Work schedules and procedures should be consistent and posted.

There you go, general principles for cleaning hospitals, clinics and other healthcare facilities summarized.

Since 1930, the International Executive Housekeepers Association (IEHA) has been a non-profit organization committed to raising professionalism in the cleaning industry and providing a cleaner, safer, healthier environment.

IEHA members are Executive Housekeepers—managers who direct housekeeping programs in commercial, industrial or institutional facilities. IEHA provides members with an array of channels through which they can achieve personal and professional growth. Some are: leadership opportunities; resource materials; education program designation; employment referral service; a Technical Question Hotline (1-800-200-6342); networking; an annual convention and trade show, including several educational sessions; and a monthly trade publication, Executive Housekeeping Today.

Take a moment and learn more about our professional organization:

No storage within 18 inches of the ceiling, except on shelves against the wall as long as sprinklers are not obstructed.

No evidence of smoking.

All exit signs are illuminated.

No storage of flammables or anything except cleaning items under sinks.

No door stops are allowed.

All equipment must be placed on one side of the hallway. Preferably nothing is in the hallway except crash carts and isolation supply tables.

Abate all trip hazards (secure cords).

Ensure stairwells are clean and no equipment is stored there.

All chemicals are labeled and your chemical list is available.

Do not block fire pull boxes, fire extinguishers or medical gas shut offs.

No evidence of smoking, no butts within 25′ of an entrance.

All gas cylinders in racks.

No visible dust or dirt on surfaces, floors or equipment.

No linen on floor, furniture or window sills; soiled linen in closed bag or covered hamper. All clean linen is covered.

No employee food/drink in patient refrigerators or at nurses stations. No food or drink on or in housekeeping cart or closet.

Check stairwells for trash and storage.

When an agency inspector comes to inspect your hazardous waste storage area, he looks for things like waste manifests, reports, labels, and plans. Why? Because it is easy to find violations in these areas – either you have filled them out properly or you have not. It is straightforward.

The video below is from an inspector at the California Department of Toxic Substances (DTSC). Listen to what the DTSC inspector has to say about what he looks for in your hazardous waste labels.

Here is a short video from California’s DTSC on the training requirements for hazardous waste generators:

The California Department of Toxic Substances Control (DTSC) has a short video clip on how to determine reactivity. In general, if something is going to go “boom”, it is likely to be reactive. Or if the MSDS states that a material is reactive with water or unstable, the waste that is derived from that material is likely to be a reactive waste. Enjoy the video.