1. World Health Organization
21 January, 2018
Module 7
Cleaning & Disinfection
WASH FIT

2. Overview Cleaning, disinfection, decontamination
When to use cleaning, disinfection, or sterilization
The cleaning, disinfection and sterilization process
The safe management of used linen
Cleaning of reusable PPE (Ebola)

3. What is decontamination?
Decontamination is the process of making an object or area safe by removing contaminants such as micro- organisms or hazardous materials, including chemicals, radioactive substances, and infectious substances. Decontamination process: Cleaning, Disinfection and Sterilization

4. Why is decontamination important?
To prevent the spread of micro-organisms and other contaminants that may threaten the health of human beings or animals or damage the environment.

5. Principles of cleaning and disinfection
Always move from cleanest area to dirtiest area
Always be sure to clean patient care equipment between each patient use
One bucket = One job
Buckets for specific purposes must be labeled and/or colored
Cleaning supplies for isolation should be kept and only used in isolation
Where possible, the isolation area should be cleaned last..

6. Cleaning
General removal of debris (dirt, food, feces, blood, saliva and other body secretions)
Reduces amount of organic matter that contributes to proliferation of bacteria and viruses.
By removing organic matter, increases effectiveness of chemical disinfection

7. Cleaning process (6 steps)
Remove rubbish / Recycle
Remove liners and reline all waste containers.
Remove soiled linen. Change the bag when ¾ full or if the area is closed for the day.
Check sharp containers (change when ¾ full).
Clean waste containers.
Dust
Always use a wet cloth to dust
High dust everything above shoulder level or out of reach. Use an extension pole with duster head.
Never high dust around people.

8. Cleaning process (6 steps)
Damp wipe
Wipe everything you are able to reach.
Use germicide for all surfaces except glass.
Use a dry cloth or paper towel to polish interior and low-level glass to a streak free appearance.
Start with the door and work around the room in a circular pattern.
Be sure to include: wall spotting, light switches, call buttons, telephones, wall moldings, dispensers, windowsills, and furniture.
Clean bathrooms
Start at the door and end with the toilet. Use a bowl mop inside the bowl and wipe the outside with a disinfectant damp wiper.
Do not use the cleaning wiper on any other surface after cleaning the toilet.

9. Cleaning process (6 steps)
Damp mop
Place a ‘Wet Floor’ sign at the entrance before you begin.
Start with the corner furthest from the door and work your way out.
Mop the corners to prevent build up of dust and dirt.
Inspect the room
Report any repairs that are needed.
Correct any deficiencies.
Is the room ready for another patient?

10. Disinfection
Removes most organisms present on surfaces that can cause infection or disease

11. Disinfection process (4 steps)
CLEAN using soap or detergent and water
Remove visible soil
May need to disconnect or separate instrument parts
Avoid organic material drying on equipment by rinsing or soaking in an enzymatic solution
DISINFECT using an effective and approved disinfectant
WASH OFF any remaining disinfectant using clean water
Let air DRY or take outside to dry in the sun
NEVER SPRAY disinfectant directly on spill body fluid, it can create splashes or make the spill bigger
Use towel or cloth to remove any spill

12. Materials for cleaning and disinfection
Risk appropriate personal protective equipment
Detergent and water
Cloths and towels
Bucket and mop
Disinfectant
Non-infectious waste bag
Infectious waste bag

13. Sterilization
The killing or removal of all organisms

14. Sterilization (Steam Autoclave)
Achieves rapid heating and penetration
Short exposure times(<20minutes) but temperature must be maintained throughout
No toxicity to workers
Can damage delicate instruments
Items to be sterilized must be
Cleaned
Packaged so that the steam can penetrate
Autoclave must be loaded correctly
Liberia hospital, November 2015

15. Rapid Cycle or Flash Sterilization
“Unwrapped” steam sterilization
Should only be used when necessary
Do not flash whole trays of instruments
Items must be used immediately
Items to be sterilized must be cleaned
Must be loaded correctly

16. Cleaning and disinfecting an Isolation Area
Cleaners should always wear the recommended PPE when cleaning the isolation area
Isolation areas should have their own cleaning supplies that are separate from clean patient care areas
All waste from the isolation area is considered infectious waste

17. How to manage used linen (in the Ebola context )
All linen should be handled as if contaminated with blood or body fluids
When handling used linen wear PPE (face shield or mask and goggles, gown and gloves)
Place linens, at point of use, into leak-proof bags or buckets labeled “soiled” for transport to laundry
Before washing the linen remove any waste and rinse excess blood
Use a washing machine (preferable)
Laundry equipment must be maintained functional
This is not relevant for all contexts and may be removed if preferred.

18. How to Clean Reusable PPE
Collect PPE items (boots, rubber glove, aprons, and goggles) from the doffing area
Remove any waste and wash off any blood
Wash with soap and water
Soak in appropriate disinfectant
Rinse with clean water
Hang to dry
This is not relevant for all contexts and may be removed if preferred.
Module 13: Environmental Cleaning

19. Recommended frequency of cleaning
Item
Frequency
High hand touch surfaces (any surface with frequent contact with hands)
Clean with detergent followed by disinfectant between cases
Minimal touch surfaces (floors, walls, tables, chairs)
Regularly cleaning (at least daily) with detergent only or when soiling occurs
Clean after a patient has been discharged
Medical equipment (axillary thermometers)
After every patient
Refer to manufacturer's instructions
Plates and utensils
Reusable PPE
(aprons, boots)
After procedures
After exiting an isolation area
When visibly soiled
Linens and mattresses
Environmental Cleaning

20. Recommended frequency of cleaning
Place
Frequency
Screening area
At least twice daily
After a patient with a suspected infectious disease
Isolation area
At least once daily
After every patient
Non-Patient care areas
Latrines/toilets
When visibly soiled
All areas
Immediately following possible contamination with blood or body fluids
Environmental Cleaning

21. Cleaning staff
REMEMBER! Cleaners and support staff should be valued as much as clinical staff

22. Cleaning & disinfection indicators (1)
3.8 Floors and horizontal work surfaces appear clean. 3.9 Appropriate and well maintained materials for cleaning (i.e. detergent, mops, buckets, etc.) are available At least two pairs of household cleaning gloves and one pair of overalls or apron and boots in a good state, for each cleaning and waste disposal staff member At least one member of staff can demonstrate the correct procedures for cleaning and disinfection and apply them as required to maintain clean & safe rooms

23. Cleaning & disinfection indicators (2)
3.13 A mechanism exists to track supply of IPC-related materials (such as gloves and protective equipment) to identify stock-outs Record of cleaning visible and signed by the cleaners each day Laundry facilities are available to wash linen from patient beds between each patient. NB: the missing indicators are covered in other modules

24. Questions