Environmental Cleaning Tool Kit Cleaning Basics Module 1 Funded through the AORN Foundation and supported by a grant from Ecolab

AORN Environmental Cleaning Toolkit

Objectives Upon completion of this module, participants will be able to define standard precautions; describe appropriate cleaning methods; explain the chain of infection; state high-touch objects in the perioperative environment; describe how often cleaning should occur, and; state the recommended chemicals, tools, and equipment used for cleaning.

Cleaning Precautions The Occupational Safety and Health Administration (OSHA) regulates the bloodborne pathogens standard to protect all health care workers from exposure to germs that can be spread in blood and body fluids Team members must wear protection during cleaning in the perioperative area to avoid coming in contact with any potentially infectious substance this is called standard precautions Provide a copy of the OSHA Bloodborne Pathogen standard now. Ask personnel if they have heard this information before. Have personnel share what this means to them.

Standard Precautions Team members cleaning contaminated surfaces must wear personal protective equipment (PPE) Refer to OSHA BBP Standard and your facility based policy here.

Types of PPE - Gloves Team members must wear gloves when you might come in contact with blood, bodily fluids, or other potentially infectious material while touching or handling contaminated items or surfaces

Types of PPE – Face Protection Team members must wear masks, eye protection, and face shields when you might come in contact with splashes sprays, splatter, or droplets of blood bodily fluids, or other potentially contaminated materials Explain to personnel why this is important. Provide examples of when masks, eye protection, and face shields must be worn.

Hand Hygiene Hand hygiene must always be performed when you remove PPE as soon as possible after hands are soiled Discuss with personnel that hand hygiene is the number one way to stop the spread of infection. Lack of proper hand hygiene can not only potentially infect the personnel, but other patients if a microorganism is on their hands. Talk about hand hygiene using alcohol based hand rubs and traditional hand washing with soap and water. If hands are visibly soiled, washing hands with soap and water is required.

Definitions Clean Disinfection the absence of visible dust, soil, debris, blood, or other potentially infectious material Disinfection a process that kills most forms of microorganisms on inanimate surfaces Go through definitions with personnel as an introduction to terminology that will be presented later in the session.

Definitions High-touch objects Dwell time frequently touched items or surfaces Dwell time the amount of time required for contact of a chemical agent with a surface Go through definitions with personnel as an introduction to terminology that will be presented later in the session.

Definitions Terminal cleaning thorough environmental cleaning that is performed at the end of each day when the area is being used Turnover clean cleaning and disinfecting done to a room between patients throughout the day

Why is cleaning important? There is a high risk for spreading germs in the perioperative environment common equipment used on every patient team members touch the patient, touch equipment, then touch the patient again patient is at higher risk for infection because of surgery In the procedural areas, the patient is the center of activity. Personnel come in and out of the room where the patient is being cared for; nurses, doctors, family and friends. As the patient moves through Pre-op, OR, PACU, and Post-op, he or she moves several times during the process, from room to room. One room may have several patients come in for care during one day. This is different than in an inpatient room, where the patient stays in one place most of the time. Because the equipment stays in each room, numerous patients could be touched with the same equipment during a day. The only way to keep each patient from coming in contact with the germs from the last patient is to thoroughly clean the equipment between patients. Patients coming in for surgery are at a higher risk for infection because their normal barrier to infection, their skin, may be cut during surgery. Surgery is a stressful time for patients, and the physical stress of surgery to the body can also increase the risk of infection.

Cleaning & Disinfection Chain of Infection Microorganism Reservoir Portal of Exit Means of Transmission Portal of Entry Susceptible Host Cleaning & Disinfection Hand Washing The chain of transmission is a series of well defined events or entities that need to occur in a pattern for an infection to happen. We can decrease the chance of a patient getting an infection by breaking any one of the links in this chain. (describe the links) By targeting the means of transmission (the way germs get around) and the reservoir (hiding places where germs can live on surfaces) we decrease the amount of infectious agents (the germs) before they can ever reach the susceptible host (the patient who could get sick). Waste Removal Hand Washing

Why is cleaning important? Cleaning environmental surfaces decreases the amount of germs in the area around the patient Decreases the chances of our patients having a health care-associated infection (HAI) after surgery Every patient should be provided with a clean, safe environment.

How often should we clean? Always follow your health care facility’s policy regarding frequency of cleaning patient rooms terminally clean all patient rooms terminally daily if being used clean every room between patients, especially high-touch objects damp dust horizontal surfaces at the beginning of the day Identify what your facility's policy is for cleaning in the perioperative environment and share your policy with personnel during this slide. Also inform personnel where they can go to find the policy in their unit. Damp dusting is normally done by the perioperative personnel, but environmental services personnel should know what damp dusting is and how it is done.

Cleaning Schedule Areas and equipment that are not terminally cleaned daily will be cleaned according to your facility’s schedule (weekly or monthly) ventilation ducts clean and soiled utility rooms sterile storage areas sterilizers lounges refrigerators Always follow your facility’s specific policy for cleaning these areas Document your cleaning on your facility’s cleaning log These items are not in the patient rooms within the perioperative area. Some items such as ventilation ducts and ice machines may be on a maintenance schedule through your biomedical, facilities, or maintenance departments. Coordinate your cleaning schedule with the preventative maintenance schedule, if possible. If your health care facility has a cleaning log for documentation purposes, please share a copy of this log with personnel now. Review the documentation requirements with personnel. Identify where this log is kept for personnel knowledge.

Types of Environmental Cleaning Terminal cleaning Damp dusting Turnover cleaning We will discuss each of these types of cleaning in more detail on the following slides.

Types of Cleaning Terminal cleaning performed every day when the room is being used Involves cleaning and disinfecting of all exposed surfaces, including wheels and casters, of all equipment cleaning and disinfecting the floor with a wet vacuum or single-use mop moving equipment around the room to clean the floor underneath More in-depth discussion regarding terminal cleaning will occur in subsequent Modules in this series. The key to remember is terminal cleaning is very thorough, involves everything in the room, both horizontal and vertical surfaces, and is performed every day the room is in use, after the last scheduled patient has received care for that day.

Types of Cleaning Damp dusting use a clean, low-linting cloth moistened with disinfectant damp dust first thing in the morning before additional items or equipment are brought into the room damp dust from top to bottom Why damp dust? removes dust from horizontal surfaces This slide is for personnel information only. Most environmental services personnel will not perform damp dusting, but they should all know what this term means and the frequency of damp dusting in the operating room.

Types of Cleaning Turnover cleaning patient rooms must be cleaned after each patient high-touch objects and equipment contamination of items that are frequently touched can lead to contaminated hands for health care personnel This type of cleaning is sometimes referred to as “turn-over cleaning.” During room turn-overs between patients, personnel need to ensure all items used during the care of the last patient are cleaned and disinfected before bringing the next patient into the room. If these items are not cleaned between patients, the patient can be at an increased risk for infection.

High Touch Objects High-touch objects are anesthesia machine, carts, and equipment call lights IV poles and pumps OR bed over-bed tables patient beds patient monitors reusable table straps (safety straps) television remote controls

Cleaning in the OR or Procedure Room Discuss this slide with personnel. Have them point out objects in the picture and identify the frequency of cleaning. Make this interactive so personnel understand the purpose behind the recommended cleaning practices. Adapted with permission from Perioperative Standards and Recommended Practices. Copyright © 2014, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved.

Cleaning in the OR or Procedure Room Discuss this slide with personnel. Use this as a guide related to the order of cleaning. Dust, debris, and contaminated cleaning solutions may contaminate items below if cleaning is not performed from top-to-bottom. The reason to clean from clean-to-dirty is to avoid potentially spreading germs from dirty areas into cleaner areas. Depending on the space, a clockwise or counter-clockwise may be used, but it should never replace the foundational methods of top-to-bottom or clean-to-dirty. Adapted with permission from Perioperative Standards and Recommended Practices. Copyright © 2014, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved.

Cleaning in the Preoperative and Postoperative Patient Care Areas Discuss this slide with personnel. Have them point out objects in the picture and identify the frequency of cleaning. Make this interactive so personnel understand the purpose behind the recommended cleaning practices. Adapted with permission from Perioperative Standards and Recommended Practices. Copyright © 2014, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved.

Cleaning in the Preoperative and Postoperative Patient Care Areas Discuss this slide with personnel. Use this as a guide related to the order of cleaning. Dust, debris, and contaminated cleaning solutions may contaminate items below if cleaning is not performed from top-to-bottom. The reason to clean from clean-to-dirty is to avoid potentially spreading germs from dirty areas into cleaner areas. Depending on the space, a clockwise or counter-clockwise may be used, but it should never replace the foundational methods of top-to-bottom or clean-to-dirty. Adapted with permission from Perioperative Standards and Recommended Practices. Copyright © 2014, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved.

Cleaning in Sterile Storage Areas Discuss this slide with personnel. Have them point out objects in the picture and identify the frequency of cleaning. Make this interactive so personnel understand the purpose behind the recommended cleaning practices.

Cleaning in the Clean Packing Area Discuss this slide with personnel. Have them point out objects in the picture and identify the frequency of cleaning. Make this interactive so personnel understand the purpose behind the recommended cleaning practices.

Cleaning in the Sterile Processing Areas Decontamination Area Discuss this slide with personnel. Have them point out objects in the picture and identify the frequency of cleaning. Make this interactive so personnel understand the purpose behind the recommended cleaning practices.

Floor Cleaning Clean and disinfect the floor surfaces at the edge of the room first moving toward the center of the room The center of the room is where most patient care happens the center is likely to be dirtier Have personnel explain why this is important using the clean-to-dirty cleaning method.

Cleaning Chemicals Always follow your facility’s policy when using cleaning and disinfecting chemicals in your facility the manufacturer’s instructions for use

Cleaning Chemicals You will need to know and be able to tell others if the chemical is approved for use at your facility what the “dwell time” is for the product how to mix the product (if needed) how long the chemical can be used before needing to be replaced how to label the chemical Provide specific education for personnel regarding how long each product must be on surface areas before the item is disinfected (dwell time). Include drying time in your education. Discuss if a chemical needs to be reconstituted with water before use. How much? What do you use to measure? How long can the chemical be used before it must be replaced (expiration date, daily)? This will depend on the specific product. Go over the correct labeling requirements for each product. Let personnel know that surveyors will ask personnel these questions during an on-site survey.

Cleaning Tools and Equipment The tools and equipment you will use to clean your facility may vary based on what your facility provides reusable or single-use mops microfiber cloths single-use wipes Do not use spray bottles for cleaning surfaces they could cause germs to go into the air Identify what types of cleaning tools and equipment your facility provides now. Talk through the processes used for disposal of the equipment once used.

Cleaning Tools and Equipment “Courtesy of Ecolab® Inc.”

Cleaning Tools and Equipment Talk about the various types of tools and equipment shown. Identify for personnel what products are used at your facility.

Resources Association for the Healthcare Environment of the American Hospital Association. Practice Guidance for Healthcare Environmental Cleaning. 2nd ed. Chicago, IL: American Hospital Association; 2012. Recommended practices for environmental cleaning. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014:255-276. Sehulster LM, Chinn RYW, Arduino MJ, et al. Guidelines for Environmental Infection Control in Health-Care Facilities. Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004. http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_hcf_03.pdf Accessed January 13, 2014. Please use the above resources for additional guidance, if needed.