Best Practices for Environmental Cleaning Module 2 – Routine Practices Welcome to Module #2- Routine practices. This is the second module in the training program developed in support of the Best Practices document on Environmental Cleaning for prevention and Control of Infection in Health care settings developed by the Provincial Infectious Diseases Advisory Committee. Health Care settings are encouraged to work towards best practices in an effort to improve quality of care and prevent healthcare acquired infections. My name is insert name and title and I will be your presenter for this module.

Building a Culture of Safety Employers have responsibilities to keep employees safe in the workplace Their responsibility includes having clear policies and procedures and educating staff regularly The employee too, has responsibilities to work safely which includes following the workplace’s policies and procedures This module discusses routine practices a system to keep you safe in the workplace. Part of the culture of safety is using Routine practices Employers have a responsibility to keep employees safe in the workplace Their responsibility includes having clear policies and procedures and providing regular training to staff. The employee too has responsibilities- it includes working safely and following the agencies policies and procedures 2 2

Why follow Routine Practices? Prevents Transmission of Microorganisms . . . . . . from Client to Staff . . . from You may ask yourself, Why follow Routine Practices? This is because routine practices prevent transmission of germs from client to client, from client to staff, from staff to client and from staff to staff It also prevents you taking germs home to your families or spreading germs to families that are visiting. It is important to keep the work germs at work and not to bring germs from home to the workplace.

Routine Practices Routine Practices Are used for all patients/residents/clients Include risk assessment and risk reduction Are based on the fact that all body fluids and mucous membranes contain germs Reduce exposure to body fluids by health care provider and others Read slide 4

Three Components Risk assessment: What am I walking into? Risk reduction strategies: How do I protect myself? Education: Am I keeping up to date? There are three main components of routine practices. These are: Risk assessment – what are you going to do Risk reduction strategies and - how to protect yourself Education – improving your knowledge to protect yourself and your clients 5 5

Why follow Routine Practices? For everyone’s safety! Read slide 6 6

Remember that Germs are everywhere, so always use Routine Practices! We should Remember that Germs are everywhere, so it its always important to use routine practices 7 7

Risk Assessment should be done: At the beginning of your shift and Before entering a client’s room or bed space At beginning of shift: Ask unit staff if there are any concerns that environmental services need to know? Risk Assessment is the first step in prevention and a very important part of routine practices. It should be done at the beginning of each shift and before entering each room. At the beginning of each shift check with staff on the unit to find out if there are any concerns that have not been communicated to Environmental Services such as patients being placed on precautions. Before you enter each room: Look for signage that might indicate the need for additional personal protective equipment or cleaning practices Before you perform any task: Assess your risk. Ask yourself whether you know how to perform the task and also what the likelihood of being exposed to blood and/or body fluids is? If you don’t know how to perform the task, speak with your supervisor to make sure you have the training to allow you to work safely. There are several ways you may be exposed to blood and/or body fluids Contaminated equipment and surfaces as well as direct exposure to blood, body fluids, secretions and tissues of the patient/resident. It is important that you ask yourself what the risk of this type of exposure is and choose the correct barriers to reduce your risk. 8 8

Risk Assessment Before entering the patient’s/resident’s room: What are you walking into? Look for signage Do you have what you need to do this task? If not, get the information/equipment you need Are there any behavioural issues? Be aware Before entering the patient/resident’s room ask yourself: Read bullet points 9

Safety Coming in contact with the following may increase your risk: Patients/residents/clients with broken skin Used equipment or soiled surfaces Blood, body fluids, secretions Soiled tissues In order to perform a risk assessment you need to know what may increase your risk. There are more germs present on abraded or scratched skin, used equipment, blood and body fluids and soiled tissues, to break the chain of transmission a person needs to put on some personal protective equipment, more commonly referred to as PPE. Gloves are the most common PPE used when coming into contact with these. 10 10

Other factors to consider A cluttered environment makes the room more difficult to clean Other factors to consider in your risk assessment are: How cluttered is the environment? A cluttered environment can increase the risk of transmission through indirect contact with contaminated items 11 11

Summary of Risk Assessment Perform a risk assessment before entering each room STOP To summarize, it is important to perform a risk assessment before each interaction with a patient/resident or his/her environment in order to determine what steps you should take to prevent transmission THINK PROTECT YOURSELF 12 12

Learning Checkpoint Here is a learning checkpoint. Ask the group the question on the next slide. 13 13

True or False? Risk assessment: Should be done on clients that are on additional precautions only Involves asking yourself a series of questions before entering a client’s room Involves checking in with appropriate staff for special instructions Read slide 14 14

Learning Checkpoint Answers Risk assessment: Should be done on clients that are on additional precautions only - FALSE Involves asking yourself a series of questions before entering a client’s room - TRUE Involves checking in with appropriate staff for special instructions - TRUE The correct answers are; Risk assessment: 1. Should be done on clients that are on additional precautions only - FALSE - A risk assessment should be done on all clients 2. Involves asking yourself a series of questions before entering a client’s room –TRUE - You need to ask these questions: Do I have what I need to do the task? Is there any signage I need to be aware of? Are there any behavioural issues with this client? 3. Involves checking with appropriate staff for special instructions - TRUE - At the beginning of the shift check with unit staff so you know what’s changed from your previous shift

2. Protecting yourself and others Based on your assessment, some of the following risk reduction strategies may be put into place. Next, we go on to reducing the risk. Based on your risk assessment, some of the risk reduction strategies we will talk about may be put into place. This section will explain how these strategies may be properly applied. These include: hand hygiene, use of PPE and Environmental Controls such as cleaning, waste handling, equipment handling, soiled linen handling and equipment cleaning 16 16

Hand Hygiene Hand hygiene is the most important factor in preventing transmission of harmful organisms! Soap and water or an alcohol based hand rub can both be used to kill the germs on your hands. Hand hygiene is the most important factor in preventing the transmission of harmful organisms! An alcohol based hand rub or soap and water can both be used to kill the germs on your hands. However, alcohol based hand rub is the gold standard for cleaning hands when your hands are not visibly soiled. Washing hands with soap and water is also more drying to your hands. 17 17

Hand Hygiene Remember the 4 moments for hand hygiene: When performing hand hygiene we look at the 4 moments of hand hygiene. These are: Before initial patient/resident/client contact – This means you should clean your hands before entering the patient/resident room or touching any object in the room. This is to protect the patient/resident from any harmful germs you may have picked up on your hands before you entered the room. Remember that wearing gloves does not replace cleaning your hands! Before aseptic procedures – This includes putting in eye drops and changing dressings. This does not apply to environmental services staff since environmental staff do not perform aseptic procedures 3. After body fluid exposure risk This means you should Clean your hands immediately after an exposure or risk of exposure to body fluids and after glove removal. This is to protect yourself and the health care environment from harmful germs that the patient/resident/client might have. 4. After client/client environment contact - This means you should Clean your hands when leaving the patient/resident’s room to protect yourself, other patients/residents and the healthcare environment from harmful germs that may be in the patient's/resident’s room. This means that gloves must be removed and hands cleaned when leaving a patient or resident’s room or bedspace For more education about hand hygiene see the Just Clean Your Hands Module for Environmental Staff 18 18

Personal Protective Equipment (PPE) Choose the proper PPE to protect yourself PPE protects you from harmful substances Some of the common PPE will be discussed Personal Protective Equipment is an important part of routine practices because it protects health care providers from harmful substances that may cause infection. You should choose the proper personal protective equipment such as gloves or gowns based on your risk assessment of the situation. Often this is done in looking at the signage. Personal Protective equipment is an important part of routine practices because it provides a barrier to protect health care providers from germs that may cause infection This section will go through some of the common personal protective equipment you might encounter and their proper use. Gloves will likely be the most common PPE you would use. 19 19

Gloves The most common PPE Task-specific and single-use Wear when there will be contact with blood and body fluids, waste and soiled linen Always perform hand hygiene before putting on gloves and after glove removal When removing remember: glove to glove for the first glove and skin to skin for the second glove Here are some key points to remember about gloves: Gloves are the most common PPE Gloves are task-specific and single-use. Use 1 set of gloves to remove trash and another to clean room- so the gloves which become contaminated from the trash container don’t spread those germs around the room while “cleaning it” They are Worn when there will be contact with blood and body fluids. -consider this quote: If it feels wet and warm and not your own then you need to wear gloves Change gloves and always perform hand hygiene before putting on and after removing When removing gloves remember: for the first glove, take glove to glove (grab the glove on the palm to prevent touching the skin). For the second glove go skin to skin by slipping your fingers under the glove. Gloves are only a barrier, so hand hygiene- using alcohol-based hand rub must be performed before wearing and after removing 20 20

own . . . then you need gloves" "If it’s wet, warm, and not your own . . . then you need gloves" The wet and warm refers to mucous membranes or body fluids- so if in contact with either put on gloves This slide is about when to put on gloves only 21

Glove use When to wear gloves When not to wear gloves Cleaning client rooms Cleaning washrooms Removing waste Handling dirty linen/laundry Making a bed Stocking rooms Hanging clean curtains Moving clean furniture In the hallway We should note when gloves should be worn and when gloves are not required for a task. Some examples of When to wear gloves are: When there’s Risk of exposure to blood, body fluids and non intact skin such as when: Cleaning showers Cleaning toilets Removing waste Handling dirty linen and laundry Some examples of When not to wear gloves are: Making a bed Stocking rooms Hanging clean curtains Moving clean furniture There may be times you need to wear gloves in the hall or outside the patient care environment to protect yourself when using certain chemicals. 22 22

Learning Checkpoint Here is a learning checkpoint. Ask the group the question on the next slide. 23 23

True or False? Gloves should be worn when pushing a cart down the hall Gloves should be worn when cleaning a body fluid spill Gloves should be worn when making a bed Gloves should be worn when removing waste Read slide

Learning Checkpoint Answers Gloves should be worn when pushing a cart down the hall - FALSE Gloves should be worn when cleaning a body fluid spill - TRUE Gloves should be worn when making a bed - FALSE Gloves should be worn when removing waste - TRUE Answers and rationale Gloves should be worn when pushing a cart down the hall – FALSE - don’t wear gloves in the hall Gloves should be worn when cleaning a body fluid spill – TRUE - wear gloves when risk of contacting body fluids Gloves should be worn when making a bed – FALSE - the bed and linen are clean Gloves should be worn when removing waste – TRUE - wear gloves when there is a risk of contacting soiled refuse

Gowns Wear if there is a risk of splashing or soiling by body fluids Gowns should be put on before any other PPE Long sleeve gowns should be worn Soiled gowns are removed right after use and hand hygiene is performed A gown should be used whenever there is a risk of splashing or sprays of blood, body fluids or secretions during a procedure e.g. sorting soiled linen, cleaning a hopper It should also be used if there is a presence of uncontrolled body drainage such as from a leaking wound or an incontinence that is not contained in briefs. If using a gown, it should be put on before any other type of personal protective equipment such as gloves or eyewear Long sleeve gowns should be worn to protect the skin from splashing Soiled gowns are removed right after use and hand hygiene is performed to prevent the spread of any harmful organisms These situations would be infrequent for Environmental Services staff. 26 26

Masks, Face & Eye Protection Facial protection is worn when there’s a risk of splashing or when within 2 meters of a coughing patient/resident/client Splashes can come from pouring liquids Masks, face shields, and safety glasses protect the eyes, nose and mouth Face and eye protection should be used whenever there’s a risk of splashing of blood or body fluids while you are in close contact with a sneezing patient/resident/client (within 2 meters or 6 feet). Masks protect the nose and the mouth while protective eyewear protects the eyes from all directions if used properly. Eye glasses used for correcting vision are not considered eye protection Most facilities have a closed chemical dispensing system. When is it appropriate to use face protection when handling cleaning products? You would only require facial protection if there was a risk of splash when pouring or dispensing liquids. 27 27

Environmental Cleaning Environmental cleaning is a critical component of Routine Practices The environment of a health care setting can contain many germs Maintaining a safe, clean environment is essential. Read slide

Other elements of Routine Practices Safe handling and disposal of sharps Cleaning up spills of blood and body fluids Proper handling and transporting of soiled linen Proper handling and disposal of waste Read slide

Healthy Workplace Taking care of yourself and getting immunizations is important to a healthy workplace Some recommended vaccines include: Annual flu vaccine Hepatitis B vaccine Tetanus Stay home from work if sick! Let’s talk about maintaining a healthy workplace- another part of routine practices -Taking care of yourself and ensuring your immunizations are up to date is an important part of maintaining a healthy workplace. -You should be aware of your health care settings` policies on when to come in and when not to come in to work if you are sick. Some symptoms that may mean you have something that can be spread to your colleagues or patients/residents include: fever, rash, uncontrolled cough or sneeze and vomiting and diarrhea -Health care providers should ensure their immunizations are up to date to protect themselves and the patients/residents. Recommended vaccines include: annual flu vaccine, Hepatitis B vaccine, measles, mumps and rubella and tetanus and diphtheria 30 30

Cough Etiquette Respiratory infections can be easily spread so it is up to the individual to take the proper precautions such as: Do not come to work when ill Take avoidance measures such as: Covering your mouth and nose when coughing or Sneeze or cough into your sleeve or a tissue Immediately dispose of used tissues and perform hand hygiene Respiratory infections can be easily spread so it is up to the individual to take the proper precautions to prevent this spread. Here are some personal practices to follow in regards to respiratory etiquette: -Do not come to work when showing signs of an acute respiratory infection. -Take avoidance measures to minimize droplets when coughing or sneezing such as: turning your head away from others, maintaining a two meter distance from others and covering your mouth and nose with a tissue -“sneeze or cough into your sleeve" -Immediately dispose of tissues into a waste basket and perform hand hygiene. 31 31

Education is important to keep everyone safe in health care Everyone is involved in preventing infections Attend staff meetings and participate in education Everyone should take a leadership role and set a good example in our facility Education is important for both health care providers and for patients/residents so that everyone can be involved in preventing the spread of infection. Education on infection control and routine practices should be ongoing so that health care providers can be aware of the most up to date information. Health Care Providers should take a leadership role and set a good example in their workplace by educating clients and fellow staff alike. 32 32

Going Forward Routine practices keep you, your patients/residents and your fellow workers safe How will you use routine practices to keep you safe? Reinforce the need to use routine practices- risk assessment of the work environment , use risk reduction strategies to protect yourself and participate in education to keep you informed about how to stay safe in the health care environment and ensure you don’t take things to your work camp from home and likewise don’t take germs from your work to home Keep everyone safe- your patients/residents, yourself, your co-workers and your family

When you return to your job what will you do differently as a result of this session? Congratulations on completing this module. We want to create a health care facility that you can be proud of and which you wouldn’t hesitate to have a member of your very own family take a part in! Following routine practices is one step which can lead to the creation of such an environment. When you return to your job, what will you do differently as a result of this session?

Thank You! This concludes Module 2 on Routine Practices. Thank you

Image Sources – Module 2 Getty Images used in Slides 7 & 16 Microsoft Clipart used in Slides 13 & 23 All other images are © PHO 2013