Every healthcare facility should have written protocols to guide routine general cleaning and ensure that all areas of the environment are regularly cleaned to a satisfactory standard. Staff undertaking cleaning should follow agreed protocols and have access to adequate resources and equipment to achieve the required standard of cleaning. COSHH regulations should always be adhered to and staff should use appropriate personal protective equipment (PPE) to protect themselves at all times.
Cleaning
Cleaning with warm water and detergent is a process that removes visual dirt and contamination and in most cases is effective for decontaminating both equipment and the environment.
However in certain situations e.g. during an outbreak, increased incidence of infection or in the case of Clostridium difficile infection, surfaces and equipment require both cleaning and disinfection.
Disinfection
Disinfection is a process that reduces the number of microorganisms to a level at which they do not present a risk to patients or clients. It is only effective if surfaces and equipment have been cleaned thoroughly with detergent and water beforehand. Warm water and detergent should be used to clean hard surfaces followed by disinfection with 1000ppm (0.1%) chlorine releasing agent/hypochlorite solution or chlorine dioxide solution (diluted, and with a contact time, as per manufactures’ instructions). The specific disinfectant to be used will be specified in the local cleaning/disinfection policy or procedure. The hypochlorite or chlorine dioxide solution will kill both bacteria and viruses provided it is used as per manufactures’ instructions. Hypochlorite solutions are corrosive and it is recommended that the solution is rinsed off commodes, mattresses and stainless steel surfaces with warm water at the end of the process. Some chlorine dioxide solutions do not need to be rinsed off.
Cleaning and disinfection of the environment
Routine General Cleaning?Routine cleaning of the environment should be undertaken at least daily. Thorough cleaning with neutral detergent and water is commonly used. If soiling (with blood and/or bodily fluids) is evident, then general cleaning should be followed with a disinfectant clean - using a chlorine releasing product/sodium hypochlorite or a chlorine dioxide solution. If using a hypochlorite solution the area should then be rinsed and dried although this is not required with some chlorine dioxide solutions.Always ensure that surfaces that are being disinfected are compatible with the product being used.
Enhanced Cleaning?During an outbreak of infection or an unusual increase in the incidence of a particular organism, enhanced routine cleaning (minimum twice daily) is recommended. This will entail cleaning/disinfecting the environment including frequently touched surfaces such as bed tables, bed rails, the arms of chairs, sinks, call bells, door handles and push plates, and any area/piece of equipment that may potentially be contaminated. Depending on the type of outbreak in the healthcare facility, certain areas will require more frequent cleaning and disinfection, e.g. sanitary areas during an outbreak of gastrointestinal infection.
Terminal Cleaning?Terminal cleaning is the thorough cleaning/disinfection of all surfaces including floors and re-useable equipment either within the whole healthcare facility or within an individual ward/department/unit. This may be required in the following circumstances:
- Following an outbreak or increased incidence of infection
- Following discharge, transfer or death of a patient who has had a known infection
- Following isolation/contact precaution nursing of a patient
A terminal clean will be advised following discussion and agreement between the Infection Prevention & Control Team and the nurse or manager in charge of the ward/unit/facility. The terminal clean should not commence until the relevant room/area has been fully vacated.
Note: The cleaning schedule for the facility should clearly advise which member of staff is responsible for cleaning different areas of the room/areas to be included in the terminal clean.
Note: In addition to the above, some facilities/organisations employ the use of other technologies such as steam or vaporised hydrogen peroxide when doing terminal cleans. This is an additional step in the cleaning process but should not replace the physical decontamination of the environment/equipment with detergent & water and disinfectant.
Terminal cleaning procedure:
- Gather all equipment required for the terminal clean at the point of use e.g. mop bucket, mop, disposable colour coded cloths, disposable roll, yellow clinical waste bags & tags, alginate & red bags, wet floor sign, vacuum cleaner fitted with a HEPA filter.
- Don Personal Protective Equipment (PPE), i.e. disposable apron and gloves, before entering the room, discard all disposables in the room/bed space/unit (e.g. hand towels, magazines, bottles, toilet rolls, etc.) All materials must be disposed of as clinical waste.
- Prepare cleaning/disinfecting solutions in a container (dilution as per manufacturer’s instruction). Do not mix chemicals and only use a cleaning product provided by your employer.
- Ventilation of the area/room being cleaned must be adequate; if there is no window, the door should be left open when applying hypochlorite/chlorine dioxide solutions.
- Disinfectant solutions should be used as per Manufacturer’s instructions, particularly the contact time. Also the Control of Substances Hazardous to Health (COSHH) regulations must be adhered to when using chemical disinfectants.
- After cleaning, rinse with water (if rinsing is required) before drying. In particular it is important to rinse chlorine containing solutions from stainless steel surfaces to prevent corrosion.
- Use disposable cloths/paper roll for cleaning during the terminal clean. Where available and appropriate, use disposable mop heads. After use, these should be disposed into a clinical waste bag before leaving the area/room.
- Ensure that PPE is changed when moving from one room/area to another and dispose into a clinical waste bag.
- Always decontaminate your hands after removing and disposing of PPE.
- Avoid leaving and re-entering the area until the terminal clean is fully completed.
THOROUGH PREPARATION AND A SYSTEMATIC APPROACH IS KEY TO ACHIEVING SUCCESSFUL TERMINAL CLEAN
Cleaning and disinfection of the environment - Click here for a step by step guide for Environmental cleaning if using detergent and water followed by a sodium hypochlorite solution
- Click here for a step by step guide for Environmental cleaning if using a combined detergent and hypochlorite solution
- Click here for a step by step guide for Environmental cleaning if using a chlorine dioxide solution
Cleaning and disinfection of equipment:
Use single use | If item is marked single use, then it must not be reused. |
Before opening an ampoule or piercing the rubber top of a vial wipe with 70% alcohol and allow drying. | Vials and ampoules should be single dose or for single patient use. |
Single patient use if headphones enter the ear canal. If external ear contact only – change covers and clean with GPD; rinse and dry. Surface disinfect with hard surface wipe. | Headphones and unit changed on discharge (or weekly for long stay patients) |
Clean with detergent and water or detergent wipe; rinse and dry. Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled. | Detergent wipes should be made available for public use. |
Clean with detergent and water or detergent wipe; rinse and dry. Clean with disinfectant or wipe with a disinfectant wipe after each use. | If soiled with body fluids disinfect with 1000ppm available chlorine. |
Clean daily (baths & showers after each use) with detergent and rinse. | For patients requiring isolation or if there is significant body fluid contamination: Clean first then disinfect with 1000ppm chlorine releasing agent. |
Daily Check clean only. If there is any soiling then wash with detergent and water, rinse and dry using disposable cloth. Weekly For long stay patients wash with detergent and water or detergent wipe weekly. | Patients in isolation: Daily Combined Detergent/ disinfectant with 1000ppm available chlorine or chlorine dioxide solution; rinse and dry. Patients in isolation: Discharge or terminal clean Wash with detergent and water, rinse and dry using disposable cloth, then disinfect with 1000ppm available chlorine or chlorine dioxide, rinse & dry. Alternatively use combined detergent/disinfectant; rinse and dry. |
Daily Wipe with handheld microfiber duster. Weekly Wash with detergent and water, rinse and dry using disposable cloth | Patients in isolation: Daily Combined Detergent/ disinfectant with 1000ppm available chlorine or chlorine dioxide; rinse and dry. Patients in isolation: Terminal clean |
Clean then heat disinfect in a bedpan washer/disinfector (>800C for minimum of 1 min). Store dry (refer to manufacturers instructions). If there is not a bedpan washer on the unit use disposable pans discarded directly into macerator. Carriers used with disposable bedpans – Carriers are washed in the bedpan washer. If one is not available on the unit/ ward then clean after each use with detergent and water, rinse and dry. Disinfect with 1000ppm chlorine releasing agent or chlorine dioxide solution if soiled. | Bedpan washers should use detergent in cycle. Disinfect bedpan carrier after each use with 1000ppm chlorine releasing agent or a chlorine dioxide solution if patient has diarrhoea or gastro-enteritis, e.g. Campylobacter/ C diff / Norovirus etc. |
Spot clean as required. When dirty clean with detergent and water. If soiled disinfect with 1000ppm available chlorine or a chlorine dioxide solution, rinse & dry. | Holders and storage racks should be disinfected periodically using 1000ppm available chlorine or a chlorine dioxide solution to limit the accumulation of C difficile. spores. |
Wash the outside of Bedpan Washer daily with detergent and water. Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled. | |
Equipment dedicated to each patient is ideal; failing this it is preferable to have equipment for each bay/area. For shared equipment: Disinfect after each patient use. If there is soiling with body fluids clean with a detergent and water prior to disinfection. | Single Patient use BP cuff must be used for patients in isolation, patients with alert organisms or patients in high risk areas such as ICU, Renal, SCBU etc. |
Washing bowls - wash with detergent and water (cream cleanser may be required for scum removal), rinse and dry. Store dry; inverted and tilted forward. | Individual wash bowls should be available for each bed-space to ensure a dedicated bowl for each patient. |
Single Patient Use accessories should be washed between use with general detergent and water, rinse and dry. Refer to manufacturer instructions for disinfection of these items. | Consider using disposable accessories. |
Lavatory Brushes - Rinse in flushing water, shake in pan and store dry in lavatory brush holder. Nail brushes - In Theatre use single use disposable brushes or packed sterile for individual use and returned to CSSD. These should not be available in wards. If their use is essential use disposable brushes. | For patients with enteric infections (Campylobacter, Salmonella, C difficile etc) rinse after use in toilet with 1000ppm available chlorine or a chlorine dioxide solution. Toilet brushes used for such cases should be disposed of after patient discharge or on cessation of isolation. |
Daily clean with general detergent, rinse and dry. Terminal clean weekly. | Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled or used by a patient in isolation. |
Clean with general detergent and water, rinse and dry. Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled; or used on a patient in isolation. Terminal clean monthly. | Make reference to manufacturers’ instructions especially regarding use of disinfectants. |
Clean with general detergent and water, rinse and dry. | Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled or used by a person with known infection. |
Clean with general detergent and water daily, rinse and dry. | |
Patients with diarrhoea or gastro-enteritis must have a dedicated commode. Pay particular attention to arm rests and under the rim; clean from top to bottom taking care to get into all edges. If possible disassemble commode for full daily clean and disinfection. | Replace commode if corroded or damaged. For any patient with diarrhoea or for any infected case, wash and then disinfect using 1,000ppm available chlorine or a chlorine dioxide solution, rinse and dry. Records of cleaning should be maintained. |
Clean at least daily with detergent wipe as per manufacturer instructions. | Flat top keyboards or keyboard covers should be considered for high risk areas e.g. Theatre, ICU, SCBU |
Daily clean with general detergent and water and disinfected using a chlorine releasing agent or a chlorine dioxide solution as required (e.g. if visibly stained with blood or bodily fluids) | |
Disinfect by heat in dish washing machine (>80°C) OR wash in detergent with hot water and rinse (approx. 55°C); rubber gloves will be required at this temperature. Dry using disposable cloth /paper towel/tissue. | If patient is isolated disposables are NOT usually required unless there is doubt over functionality of dish washer; ensure dishes are placed directly into dishwasher. |
Window Curtains Launder every 6 months or when visibly soiled. Bed Screens Change on a regular basis every 6 months or when visibly soiled. Shower curtains Change every 3 months or when visibly soiled. | Curtains and screens considered at risk of contamination from infected patients should be changed after patients discharge or cessation of isolation. Disposable bed screens should be marked with date of first use. |
Use disposable –single patient use. | |
All hand-wash pumps and dispensers to be checked cleaned daily. | Containers are not to be topped –up, pump to be replaced for each new container. |
Clean with detergent and water or detergent wipe; rinse and leave dry (refer to manufacturer instructions). Clean immediately if stained with body fluid, feed or other substance. | Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled or used by a patient who is isolated. |
Water impermeable cover: Wash with detergent solution and dry. Do not soak or disinfect unnecessarily as this may compromise the impermeability of the cover. Water permeable cover: Disinfect with 1000ppm available chlorine or a chlorine dioxide solution. If contaminated with blood or infected body fluids refer to manufacturer instructions | |
In the limited areas where these are in use wash with detergent and water, rinse and dry. | |
Nurse in charge should clear in preparation for cleaning staff to clean. Full clean weekly with detergent and water, rinse and dry. | Schedules to be agreed locally. |
Daily: check clean. Weekly: Wash inside and outside (include trays, racks around door seals) using warm water and detergent with disposable cloth and dry (refer to manufacturer instructions). | Fridge should be de-frosted as per manufacturer instructions. Cleaning should be recorded. NB: Some departments may have local variation which must be documented. |
Clean daily with detergent and water, rinse and dry. Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled or in an area where a patient is isolated. | |
Patient’s own rollers are preferable. Shared rollers – after use, remove hairs, wash in detergent and warm water, rinse and dry. | |
Hoist frame - clean with detergent and water or detergent wipe, ensuring full removal of contamination or body fluids, rinse and dry. Bath chair - clean with detergent and water or detergent wipe after each use, rinse and dry. Sling – Single patient use sling is preferable; launder/change weekly or immediately when soiled. | A single patient use sling is preferable for all patients. A single patient use sling is essential for patients in isolation or known infection. |
Clean surface of ice machine daily. See manufacturer instructions | |
Daily or after each use: clean using detergent and water or detergent wipe; rinse and dry. (refer to manufacturer instructions) | After infected cases or soiling, first clean then wipe inside with hypochlorite 125 ppm, rinse and dry by leaving open and switched on for 1-2 hours. |
Disposable blades in use Laryngoscope is needed for emergency situations- those on emergency resuscitation trolleys should be kept within the packaging to minimize contamination. When the laryngoscope is opened and checked it should then be placed inside the loose packaging to protect it from environmental contamination. | · The laryngoscope must be discarded if it is visibly soiled. · All staff must perform hand hygiene before touching the laryngoscope to check it. Local risk assessment should dictate frequency of change of unused blades. |
See toilet | |
Daily Wash with detergent and water; rinse and dry using disposable cloth Discharge or terminal clean Wash with detergent and water, rinse and dry using disposable cloth. Then disinfect with 1,000ppm available chlorine or a chlorine dioxide solution, rinse and dry. | |
See Beds | |
As per manufacturer instructions. | |
As per manufacturer instructions. | |
Detachable mop heads should be laundered daily using washing machine with appropriate detergent. Dry in a tumble dryer. Spills /Emergency Mops Access appropriate colored mop from domestic store of relevant ward/dept. RED -bathrooms/washrooms/showers /toilets BLUE - general areas including wards, depts, offices YELLOW – Isolation areas GREEN – Catering Mop Buckets: Wash with detergent and water, rinse and dry; Store inverted. | If infected place in water soluble laundry bag immediately after use. (Note:-Colour coding is by shaft handle not mop head which are all white) |
See brushes | |
Seek specific guidance for Respiratory Equipment from manufacturer. Clean unit and change filter after each patient in line with manufacturer instructions. | Seek advice from Infection Control Nurse or Respiratory Nurse Specialist |
Check clean daily. Clean weekly using detergent and water or detergent wipe. | |
Daily clean with detergent and water or detergent wipe rinse and dry. | Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled or used by a patient in isolation. |
Check clean daily with detergent and water or detergent wipe; rinse and dry. | |
Clean weekly using detergent and water or detergent wipe. | Follow with disinfection using 1000ppm available chlorine or a chlorine dioxide solution in isolation areas. |
Clean daily with detergent and water, rinse and dry | |
Protect all pillows with plastic covers. Manage as Duvets & mattresses. Clean if soiled and on discharge with detergent and water or detergent wipe rinse and dry. | Cannot be laundered. Dispose and replace if contaminated with blood or body fluids. |
Use disposable Electric razors must not be shared, but used for single patient use only. Clean as per manufacturer instructions | (Razors Not suitable for Surgical prep, Clippers with single use disposable heads only used) |
Clean with detergent and water or detergent wipe, rinse and dry | |
Clean surfaces daily with detergent and water, rinse and dry. If soiled with body fluids follow cleaning with disinfection using 1000ppm chlorine releasing agent or a chlorine dioxide solution, rinse and dry. | Sluice and dirty utility rooms should be disinfected periodically using 1000ppm available chlorine or a chlorine dioxide solution to limit the accumulation of C diff. spores. |
Should not be used – See liquid soap dispensers. | If used they should be single patient use and the soap only used by that patient. |
See Dispensers | |
Preferably use disposable. If reusable return to CSSD for autoclaving. | . |
See blood pressure equipment | |
Use disposable, discard as clinical waste | |
Disinfect after each patient use using alcohol wipe. If there soiling with body fluids clean with a detergent wipe prior to disinfection. A Stethoscope dedicated to each patient is ideal. | A stethoscope must be dedicated to an individual patient for those in isolation with a known infection. |
A bacterial filter should be fitted between vacuum source and receiver 1. The reservoir of the suction apparatus should be kept empty and dry when not in use. 2. Following use, the single use reservoir should be replaced. Dispose of in clinical waste. 3. Reusable reservoirs should be as per manufacturer instructions. 4. If unused clean unit weekly as per manufacturer instructions | Gelling granules should be used especially where there are copious amounts of fluids involved. |
Damp clean with general detergent daily (remove mains plug) | |
Use single head/sleeve for each use and discard. Clean electronic hand piece after each use per manufacturer instructions Ensure twice daily full clean of Observations trolley with detergent wipe. | Patient in isolation should have a dedicated thermometer |
Wash daily with detergent and water; rinse and dry. (Refer to manufacturer instructions). | Disinfect with 1000ppm chlorine releasing agent or a chlorine dioxide solution if soiled or used by a patient in isolation. |
Seats Clean daily using detergent and water, rinse and dry. Bowls Flush and brush daily. | After infected case disinfect with 1000ppm available chlorine or a chlorine dioxide solution and rinse. |
Single use: endeavor to phase out the use of reusable tourniquets | |
Hard surface toys only Wash with detergent and water or detergent wipes, rinse & dry. Wash weekly or when soiled. If appropriate refer to manufacturer instructions. If contaminated with blood or body fluids clean and then disinfect surface with an alcohol wipe or 125ppm available chlorine, rinse and dry. Local risk assessment should dictate frequency of cleaning –Minimum of weekly is recommended. | No shared soft toys. All toys should be washable with NO holes. Dispose if damaged. |
Clean trolley with detergent and water or detergent wipe daily. Before each use disinfect surfaces with 70% alcohol wipe. | |
See bedpans. | |
Clean with detergent and water, (refer to manufacturers instruction) rinse and dry | |
Low level :- Visible soiling should be removed immediately by thoroughly washing with detergent and water. | High Level as pre planned maintenance or local contractual arrangements. |
See baths | |
Wash with detergent and water, (refer to manufacturer instructions) rinse and dry. |