Cleaning Procedures Part 2

I wrote some general cleaning procedures back here and several people thanked me and asked for more. So I want to take some time and give you some more general and some specific cleaning procedures, along with some important definitions.

I have two ways to explain what I feel clean is. First, the absence of removable soil. Sometimes that means the object may be clean but still look bad, such as a wall that needs paint, or a desk that is scratched. It might also be that there is a stain, something that is not removable so the object does not really look clean. Second, I like to say that it will look brand new, or as close to that as possible.

In healthcare cleaning, we go beyond the look of something. It is the visible dirt that makes us unhappy, but it is the invisible “dirt” that makes us sick. We clean surfaces that may already look clean to the naked eye but under a microscope it could be crawling with bacteria.

So what is cleaning?

cleaning present participle of clean (Verb)

1. Make (something or someone) free of dirt, marks, or mess, esp. by washing, wiping, or brushing: "chair covers should be easy to clean"; "he expected other people to clean up after him"; "Anne will help with the cleaning".

What is green cleaning?

Green cleaning can be defined as “effective cleaning that protects health without harming the environment.”

The federal government has defined “green” and “environmentally preferred purchasing” as “…products and services that have a lesser or reduced effect on human health and the environment when compared with competing products and services that serve the same purpose.” — Executive Order 13101 which can be seen at www.ofee.gov/eo/13101.htm.

Both definitions focus on the impact cleaning has on the health of people as well as the impact it has on the environment. Both definitions also describe a goal of striving to make sure cleaning has as positive an impact on human health and the environment as possible. ⁽¹⁾

What is Terminal Cleaning?

Terminal cleaning methods vary, but usually include removing all detachable objects in the room, cleaning lighting and air duct surfaces in the ceiling, and cleaning everything downward to the floor. Items removed from the room are disinfected or sanitized before being returned to the room. Terminal cleaning of patient rooms should include the following steps: ⁽²⁾ 

• Using an EPA-approved, hospital-grade disinfectant, the following items should be cleaned:

> Top, front and sides of the bed’s headboard, mattress, bedframe, foot board and side rails, and between side rails

> TV remote

> Nurse-call device and cord

> All high-touch areas in the room including tabletops, bedside tabletop and inner drawer, phone and cradle, armchairs, door and cabinet handles, light switches, closet handles, etc.

• In the bathroom, start with the highest surface and clean the toilet last; clean the sink and counter area, including sink fixtures, and if there is a shower, the support bars and shower fixtures and surfaces

• Privacy curtains should be removed, placed in a plastic bag in the room and double bagged into a laundry bag with the assistance of another member of the ES staff standing at the door outside the room. The person outside the door should wear gloves. After completing the task this person should remove gloves, wash hands with an antimicrobial soap and water or apply an alcohol rub to their hands.

• Cleaning of window curtains, ceiling or walls is not necessary unless visibly soiled.

• Following patient discharge, clinical equipment must be cleaned and disinfected, moved to the door of the room for removal to central supply or to the sterile processing department.

• Following the terminal cleaning of a patient room, gloves should be removed so as to avoid touching the outside of the gloves. Hands should be washed with an antimicrobial soap and water or an alcohol rub applied to the hands prior to donning a new set of gloves.

Best Tip for cleaning:

Use microfiber towels and mops. This is the single most effective change you can make. Microfiber is a scientific discovery that is the foundation for a greener, safer, healthier environment. Microfiber is able to accumulate and absorb more particles of dirt and bacteria than any other fabric known. It can absorb up to 7 times its weight in dirt or liquid. Microfiber is a lint free, non-abrasive, and hypoallergenic product that allows you to clean without the use of chemicals. Unlike ordinary cotton towels that move, or push, the dirt and dust from one point to another, Microfiber actually gets underneath the dirt and lifts it from the surface. It then stores the dirt particles in the towel, until it is washed. Microfiber dust cloths are safe on all surfaces.

Using a traditional cotton loop mop for wet mopping in hospitals has been standard operating procedure in floor cleaning for healthcare facilities for decades. Recently, the healthcare industry has begun to look long and hard at evaluating a different method for cleaning hard surface floors within healthcare facilities with the hope of reducing chemical use, water use and increasing employee and patient health as well as improving overall cleanliness on site. ⁽³⁾

Microfiber mops are densely constructed polyester and nylon fibers able to hold 6 times their weight in water. Because the fibers are positively charged, it attracts and picks up dust (which is negatively charged), and these microfibers are able to penetrate the microscopic surface pores of any material.

Using the traditional cotton loop mop, it was required that the mop head and water be changed every two or three rooms to reduce the risk of cross contamination. This meant dumping gallons of water and chemical down the drain along with the hardship on employees of lifting the heavy bucket to do so.

Using the microfiber mops, the risk of cross contamination is reduced greatly in that you use one mop per room. With the microfiber system, 20 rooms can be cleaned using 1 and ½ gallon of water and 1 and ½ ounces of chemical.

Use of microfiber in hospitals and other organizations has been endorsed by:

• The Environmental Protection Agency (EPA)
• The American Hospital Association
• The American Nurses Association
• Association for Professionals in Infection Control and Epidemiology (APIC)

Last but not least, use some Elbow Grease                                                               

Elbow grease is an idiom for working hard at manual labor, as in "You need to use some elbow grease." It is a humorous reflection of the fact that some tasks can only be achieved by hard effort and human energy, contrasting with the idea that there should be some special oil, tool or chemical product to make the job easier. Even with green chemicals and microfiber, cleaning takes effort. You can’t swish a towel around and expect a surface to be clean. You need to put some effort in and scrub. This is one area where there are no shortcuts. Can’t get those minerals off the toilet?, scrub. Shower walls have a film? scrub it.

References:

1 http://www.waxie.com/what_is_green_cleaning_.html

2 “Practice Guidance for Healthcare Environmental Cleaning” from the American Society for Healthcare Environmental Services (ASHES).

3 American Journal of Infection Control Volume 35, Issue 9, November 2007, Pages 569 – 573 William A. Rutala PhD, MPH, Maria F. Gergen MT (ASCP) and David J. Weber MD, MPH