1. CLEANING AND DISINFECTION Presented By :Group 5
DR.NUTAN SHAH, DR.RUKMAN JINDAL, DR.RAJEEV AGGARWAL, DR.PROMILA , DR.MAHENDRA NATH THAREJA, DR.ABHISHEK KUMAR
Reviewed By-
Dr Vijay Agarwal, Dr Lallu Joseph, Dr Narayan Pendse,
Dr CM Bhagat

2. Introduction
All That Glistens
is Not Clean

3. Is It All About Cleaning?
The hospital environment is complex.
Patients, staff and visitors interact with each other and the environment
Cleaning even with interventions is rarely >85% successful*
However there are factors other than cleaning linked to risk:
1.Ward layout and content
2. Water sources – Pseudomonas aeruginosa, Legionella
3. Mechanical ventilation – protective and source isolation

4. Decontamination is NOT Cleaning
Novel decontamination
Technologies
decontaminate they
DO NOT CLEAN
2. Success of technologies : depend upon prior cleaning.
3.Increased safety = increased cost and service disruption.
If can clean properly may not be worth the investment*

5. CLEANING, DISINFECTION
DISINFECTION REDUCES MICROBIAL LOAD
STERILIZATION IDEALLY ZERO MICROIAL LOAD ICL. SPORES
CLEANING REMOVIG ORGANIC MATTER,DIRT ETC

6. Introduction
The Purpose of cleaning is to Remove unwanted contaminants from surfaces.
The methods of cleaning and the chemical products used are more Critical because they often have a dual function of removing soil and killing harmful pathogens.

7. Introduction
In Hospitals, some contaminants are disease causing micro-organisms invisible to the naked eye.
In hospitals, the purpose of cleaning is to protect patients health and prevent the spread of disease by removing contaminants from surfaces.

8. Common Infection Control Interventions
Cleaning
Surveillance
Personal protective equipment (PPE)
Isolation
Hand hygiene
Typing
Immunisation
Antibiotic stewardship
Device
management

9. Environmental Surfaces
Terms you should know
Environmental Surfaces
This term designates the surfaces that you will be cleaning in a hospital. This is a classification system for surfaces that carry a lower risk for disease transmission.
There are 2 types of Environmental Surfaces:
Housekeeping Surfaces
Equipment*
Equipment is usually diagnostic equipment such as x-ray machines, CT scanners etc.

10. Housekeeping Surfaces
Terms you should know
Housekeeping Surfaces
These are environmental surfaces that require regular cleaning including floors, walls, tabletops, fixtures, bedrails, etc.
There are two types of housekeeping surfaces you will be charged with cleaning. Each will have different methods and frequency of cleaning.
HIGH TOUCH Housekeeping Surfaces
MINIMAL HAND CONTACT Surfaces

11. MINIMAL TOUCH Surfaces
Terms you should know
HIGH TOUCH Surfaces
Surfaces that are frequently touched by
patients and staff that require more frequent
cleaning.
Examples:
Doorknobs, bedrails, light switches, wall
areas around toilets in patient rooms,
edges of privacy curtains, etc.
These surfaces must also be cleaned but not as frequently.
Floors, walls, ceilings
MINIMAL TOUCH Surfaces

12. 1968 E. H. Spaulding three categories of surfaces within clinical environments:
Non-critical = most surfaces within bed spaces as they only come into contact with intact skin
Semi-critical
Critical
Maki (1982) said that the inanimate environment contributed negligibly to HCAI
Despite this both the CDC and DoH have issued guidance on the frequency and standard of cleaning that should be reached

13. Environmental Survival
Organism
Infectious Dose
(if known)
Length of Survival on Surfaces
Staphylococcus aureus
<15Colony Forming Unit/106
(oral dose)
7 days – >1 year
Clostridium difficile
1CFU (in mouse models)
5 months
Klebsiella spp.
No experimental evidence
<1 hour – 30 months
E. coli
10 CFU
<1 hour – 16 months
Acinetobacter spp.
3 days - 5 months
Adenovirus
<150 viral copies
7 days – 3 months
Norovirus
10 – 100 viral copies
Norovirus (including Feline Calicvirus) 8 hours – 14 days
Pseudomonas aeruginosa
108 (oral dose)
6 hours – 16 months
VRE
5 days – 4 months

14. Visual Inspection
Department of Health guidance: Surfaces free of dirt, dust and debris
Study found that of 82% of sites that were considered visual clean,
only 30% were bacteriologically clean (using the Dancer surface standards

15. MONITORING MICROORGANISM

16. TOTAL VIABLE COUNT Interpretation Guidance
Griffith cut off = 2.5CFU/cm2 (60 CFU/contact plate)*
Dancer cut off = 5CFU/cm2 (120 CFU/contact plate)#
Assumptions of the Dancer criterion:
An increased microbial burden suggests insufficient cleaning
A heavy microbial burden masks the chance of finding a pathogen
If microbial contamination is heavy there is an increased chance of finding an epidemiologically related pathogen

17. A Different Way to Use TVC Data

18. Bloodborne Pathogens Special precautions have to be followed
Terms You Should Know
Bloodborne Pathogens
Special precautions have to be followed
when dealing with materials contaminated with blood or other bodily fluids.
Blood or other bodily fluids may contain
disease causing micro-organisms (pathogens) that can be transmitted to others that come in direct contact.
Examples of Bloodborne pathogens:
Hepatitis B Virus
HIV-1 Virus (AIDS Virus)
Your supervisor will provide more
specific procedures for dealing with
small spills of blood or other bodily
fluids and/or specialized cleaning
operations for larger volumes of
bodily fluids that may need to be cleaned.

19. Bloodborne Pathogens
Bloodborne Pathogen Safety Precautions
Always assume blood or bodily fluid spills are contaminated.
To clean, first obtain proper personal
protective equipment.
Disposal of cleaning materials such as rags, sponges, paper toweling, absorbents, should be placed into a red Bio-hazard bag.

20. Cleaning Up Bodily Fluid Spills
Bloodborne Pathogens
Cleaning Up Bodily Fluid Spills
Contaminated work surfaces and/or spills shall be decontaminated with an appropriate disinfectant.
Clean up gross filth by collecting with an absorbent material.
Spray surfaces with Microcide or properly diluted disinfectant .
Clean surface.
Re-apply disinfectant, allow surface to remain wet for 10 minutes.
Remember:
Always wear personal protective gear
and dispose of cleaning materials properly.
Your supervisor will instruct you on specific
procedures.

21. Protecting Yourself
Safety – Working with Cleaning Products
The products you will be working with should be developed to be safe as possible for the user.
You should always use chemicals as directed and follow prescribed safety precautions.
There are several places that you can look to determine appropriate safety equipment which includes container labels, secondary bottle labels and the MSDS.
The MATERIAL SAFETY DATA SHEET describes Possible hazards of each chemical and recommended safety precautions for using the products.

22. Safety – Working with Cleaning Products
Safety Glasses:
Safety glasses are usually worn when using any chemical product that is designated an IRRITANT or has a NFPA or HMIS rating of 1.
Safety Goggles:
Goggles protect the eyes from splashes of potentially CORROSIVE chemicals. Very few products, particularly in their diluted form would be corrosive.
Gloves:
Hand protection is usually suggested for use when cleaning with chemical products. Gloves not only protect hands from cleaning chemical exposure, they also prevent contact with soils, contaminants and potentially harmful bacteria.

23. Finding information about safe use of products
Protecting Yourself
Finding information about safe use of products
The MATERIAL SAFETY DATA SHEET describes
possible hazards of each chemical and recommended safety precautions for using the products.
A MSDS for each product used is available for you to review at any time.
Material Safety
Data
Sheet

24. Finding information about safe use of products
Protecting Yourself
Finding information about safe use of products
The container for each product identifies hazards of the chemical in it’s concentrated form. When using a dispensing system like the Multi-Task dilution control system, additional safety features are built in to the system. For instance, the “no chemical contact” seal on the container prevents accidental contact with the chemical. The locking cabinet prevents contact and / or tampering with the chemical concentrates.
Color Coded Labels
Number Codes
Instructions for Use
Health/Safety Precautions

25. Finding information about safe use of products
Protecting Yourself
Finding information about safe use of products
Secondary Packaging Labels:
When a product is diluted into another container for use, It is required that the contents are identified on the container.
In addition, basic hazards of the diluted chemical should be disclosed.

26. Protecting Patients
Sick people can spread infectious viral and bacterial agents to others, they are also often more prone to contracting illnesses.
The spread of infections within a hospital is usually spread by person to person contact. Regular hand washing is essential to help prevent the spread of infection
Infections can also be contracted by objects that are frequently touched by individuals. For the purposes of cleaning, these surfaces are referred to as “HIGH TOUCH’ surfaces and special emphasis is given to routine cleaning of these surfaces.
ALWAYS wash hands before entering a patient room. Not only does this protect the patients, it also protects YOU!
Wear the appropriate safety equipment that is recommended for use with each chemical product you may be using.

27. Common Infection Control Interventions
Cleaning
Surveillance
Personal protective equipment (PPE)
Isolation
Hand hygiene
Typing
Immunisation
Antibiotic stewardship
Device management

28. Hand Hygiene
Hand contamination occurs by touching patients and the environment
Hand hygiene is a simple but effective tool to reduce the spread of infections, but will it ever be enough on its own?
Compliance with hand hygiene varies widely between groups of health care workers
Not all stages of the WHO ‘Five moments of hand hygiene’ are complied with to the same extent
Most audits do not capture all stages

29. HAND HYGINE
*Adapted from the WHO Alliance for Patient Safety 2006

30. Floor Safety
Slip and fall accidents are among the most common types of injury accident. It is of special concern in a hospital because ill patients may lack the balance and coordination of a healthy individual.

31. Some typical reasons why someone may slip and fall?
Floor Safety
Some typical reasons why someone may slip and fall?
Physical / Mental Condition: The condition of an individual is important. In health care institutions, this is an obvious concern.
Footwear: The shoes/socks can influence slip fall accidents.
Weather Conditions: Rain/snow tracked onto floors can make floors slippery.
Maintenance Operations: Floors undergoing maintenance operations such as stripping, finishing or daily wet cleaning can be slippery when wet.
Spills / Contamination; Fluid Spills occur on floors that can make floors slippery. The most common type of spill or contaminant is water and /or beverages.
Obstacles in Walking Path: Low profile obstacles can be a tripping hazard.
Incorrect Maintenance: Using the wrong products on floors can impact slip resistance.

32. What can I do to prevent slip and fall accidents?
Floor Safety
What can I do to prevent slip and fall accidents?
When conducting any wet maintenance procedures on floors you should:
Post wet floor signs at the beginning and end of the area.
Restrict access to the area while undergoing maintenance by using caution tape or other barriers.
Wait until floors are completely dry before removing signs and allowing traffic to proceed.

33. What should I do when a slip or fall occurs?
Floor Safety
What should I do when a slip or fall occurs?
Make sure the person is comfortable.
Do NOT move the person.
Call healthcare staff for assistance.
After the person is taken care of:
Make note of any witnesses
Note the condition of the floor
What type of footwear was the person wearing.
Prepare an accident report with the help of
your supervisor.

34. Using Multi-Clean Products
You will be using the Multi-Task Dilution Control System from Multi-Clean to dispense most cleaning products into buckets or spray bottles.
Buttons to activate
dispenser.
Short hose for filling
spray bottles..
View window shows
which product is
being dispensed.
Long hose for filling
buckets or equipment.
Products:
#256 Century Q
#2 Multi-Shine
#3 Eliminator
#4 Foamy MAC
#5 Century Maintenance
#11 Odor Control
#13 Extraction Cleaner

35. Red Description: Disinfectant Cleaner for use
anywhere a disinfectant is required.
Color Code: Number: 256
Where is it used: This product is used for all
environmental surfaces, floors, general cleaning / disinfecting of restrooms
How is it used properly: Apply solution to surface to be cleaned. To properly disinfect surfaces, the surface should be left wet, and allowed to air dry in order to achieve proper contact time.
Safety Precautions in using and handling:
Floor Safety: Post wet floor signs and restrict access if possible until floor is dry.
Personal Safety: Wear gloves and safety glasses.
Red

36. Blue 2 Multi-Shine Description: Glass and surface cleaner
Color Code: Number: 2
Where is it used: Cleaning glass, mirrors and other polished metal surfaces that do not require disinfecting.
How is it used properly: Spray surfaces lightly, then wipe with clean cloth until dry.
Safety Precautions in using and handling:
Personal Safety: Wear safety glasses and gloves.
Blue

37. Purple 3 Eliminator Description: Heavy duty spray and
wipe cleaner for tougher cleaning task.
Color Code: Number: 3
Where is it used: A stronger cleaner that removes fingerprints, ink marks, oily soils.
How is it used properly: Dilute into properly labeled spray bottles. Spray unto surface to be cleaned, then wipe with a clean cloth.
Safety Precautions in using and handling:
Personal Safety:
Purple

38. Green 4 Foamy MAC Description: General purpose restroom,
shower and tub cleaner. Removes hard
water scale, and soap scum.
Color Code: Number: 4
Where is it used: Restrooms, sinks, showers, tubs to remove soap scum and hard water scale.
How is it used properly: Best used with a Foaming Trigger sprayer to achieve cling on vertical surfaces.
Spray surfaces from the top down. Allow to stand 1-2 minutes, scrub with sponge, deck brush, or pad.
Safety Precautions in using and handling:
Concentrate: Corrosive to eyes, irritating to skin.
Diluted Form: Irritating to eyes and skin.
Personal Safety: Wear splash goggles and gloves.
Green

39. Lt. Blue 5 Century Maintenance
Description: A neutral floor cleaner for
everyday cleaning of floors where a
disinfectant is NOT required.
Color Code: Number: 5
Where is it used: Use on common area floors where disinfecting is not required. Use in buckets for damp mop, or in automatic scrubbing machines.
How is it used properly: Lightly mop surfaces and allow to air dry. For scrubbers, fill solution tank with solution.
Safety Precautions in using and handling:
Floor Safety: Post wet floor signs and prevent access
to cleaned area until floor is dry.
Personal Safety: Wear safety glasses.
Lt. Blue

40. Lt. Orange Description: Odor neutralizer and
11 Freshence Odor Control
Description: Odor neutralizer and
counteractant. Leaves a fresh scent.
Color Code: Number: 11
Where is it used: To control and counteract foul or undesirable odors in trash, soiled linen containers.
How is it used properly: Spray directly onto odor causing source including soiled linens, garbage chutes or containers.
Safety Precautions in using and handling:
Personal Safety: Wear safety glasses and gloves.
Lt. Orange

41. Lt. Green 13 Extraction Description: Carpet cleaning product for
Use in extraction equipment.
Color Code: Number: 13
Where is it used: This is used as a cleaner in carpet extraction equipment.
How is it used properly: The product is diluted into the solution tank of extractor.
Safety Precautions in using and handling:
Floor Safety: Keep people off clean carpet until it is dry.
Personal Safety: Wear safety glasses.
Lt. Green

42. Vinyl tile, sheet vinyl, terrazzo
Floorcare
Vinyl tile, sheet vinyl, terrazzo
Floor Finishes are designed to protect flooring and provide a shiny, easy to clean, floor surface.
To keep the floor looking clean and shiny, it must be maintained properly.

43. Wet Cleaning: Removes adhered dirt, soil, and other contaminants.
Floor Maintenance
The 3 R’s of Floor Care
Routine Maintenance: Typically done on a daily basis. Keeps up the shine, extends finish life.
Dry Dust Mopping: Removes gritty dirt from floor that scratches the finish.
Wet Cleaning: Removes adhered dirt, soil, and other contaminants.
Burnishing: Restores shine to the floor.
Restorative Maintenance: Typically done once every 3-6 months, keeps floor looking bright and shiny, replaces worn out coats of finish.
Scrub and Recoat: Removes a single coat of finish to allow application of new coats.
Renovative Maintenance: Done as little as necessary. Emphasis on the first 2 R’s helps reduce frequency of stripping.
Stripping: This process completely strips all coats of seal and finish. Afterwards, the seal and finish are then reapplied.

44. Floor Care
Stripping of Floors
Stripping off old finish from floors requires special safety precautions.
You must ALWAYS Post Wet floor signs and restrict access to stripping areas by using Appropriate barriers.
Stripping solutions are slippery, wear appropriate footwear when stripping.
Use cool/cold water for diluting strippers for maximum performance and lowest odor.
Wear appropriate eye and skin protection. Clothing (pants, socks, shirts) that get wet with stripper should be removed promptly. Skin irritation or chemical burns could result.

45. Example of Sealers include:
Floor Care
Sealing of Floors
After stripping, sometimes a sealer is applied before applying floor finish.
Sealers help fill porous surfaces and provide a smooth surface for application of finish.
Sometimes, sealers are used because they offer special stain resistance properties.
Example of Sealers include:
StainLess
Acryl-Kote

46. Maintenance of carpeting involves 3 different types of procedures……
Carpet Care
Maintenance of carpeting involves 3 different types of procedures……
Routine: Daily maintenance that includes vacuuming and carpet stain removal.
Interim: Cleaning of carpet using a bonnet or other type of cleaning tool.
Restorative: This is cleaning using a portable hot water extractor.
Vacuuming is the single most important
maintenance procedure that will keep carpet
looking its best and extend its life.

47. OT DISINFECTION
1.CLEAN EACH AND EVERY HORIZONTAL SURFACE
2.STORE CONSUMALES ONLY FOR ONE SURGERY IN OT
REPLACE FOR NEXT SURGERY

48. Novel Decontamination Technologies
1.Hydrogen peroxide
2.Two main platforms: Glossair
Bioquell
Either dry mist or vapour depending on system.
Safety issues possible with use VRE acquisition has been reduced by 80% through use
UV-C
Virucidal
Targets nucleic acids
Light travels in straight lines – doesn’t work well on complex shapes due to shadows*
Limited studies currently available

49. Movement Tracing

50. There are certain terms used in cleaning and maintaining health care facilities that you need to know and understand.

51. Working safely is important for your own protection as well as the protection of fellow employees, hospital staff, patients, and visitors.

52. Knowing the cleaning products and how they are used is an important part of your job.
THANK YOU