Environmental Cleaning

Overview

In healthcare settings, microorganisms (bacteria, fungi, viruses) are present throughout the environment and can cause infection. The environment can serve as a breeding ground for these organisms. Cleaning and disinfecting surfaces and medical equipment, especially those that are frequently touched, is important to decrease and prevent the spread of these organisms to people.

For Healthcare Providers

1. Only use disinfectants registered with the U.S. Environmental Protection Agency (EPA).
2. Directions for cleaners and disinfectants should be reviewed for use, dilution, contact time, and shelf life.
1. Contact time: amount of time needed for the chemical to come in contact with the microorganism so that a significant number of organisms are killed.
3. Housekeeping surfaces (e.g., floors, table tops) and other environmental surfaces should be cleaned and disinfected regularly, when spills occur, and when visibly dirty. Medical equipment that is shared should be cleaned and disinfected between patients. Follow your facility’s schedule for routine cleaning and disinfection and for terminal cleaning of rooms when preparing the room for the next patient.
4. Use a disinfectant appropriate for the situation.
1. For example: C. difficile and norovirus contaminated areas may need different cleaners and disinfectants
5. How to prepare a solution using household bleach (5.25%-6.15% hypochlorite):
1. 1:10 dilution
1. 1 part bleach to 9 parts water
2. 1 ½ cups bleach in 1 gallon water
3. Example of when this dilution is recommended: for routine environmental disinfection in units with high rates of endemic Clostridium difficile infection or in a Clostridium difficile outbreak setting
2. 1:100 dilution
1. 1 part bleach to 99 parts water
2.  1/4 cup bleach in 1 gallon water
3. Example of when this dilution is recommended: for cleaning small blood spills (i.e. a few drops of blood)

Different types of equipment and environmental surfaces need different levels of cleaning, disinfection, or sterilization depending on the use of the item/surface and the risk of becoming infected with germs that may be on the item/surface.

1) Critical items are items that enter normally sterile tissue or the vascular system or through which a sterile body fluid (e.g., blood) flows. These items are associated with high risk of infection if they are contaminated with any microorganism and must be sterilized before using. Examples include surgical instruments, cardiac and urinary catheters, and implants.
 
2) Semicritical items are items that contact mucous membranes (e.g., eyes, nose, or mouth) or non-intact skin. At a minimum, semicritical items require high-level disinfection using chemical disinfectants and rinsing with sterile water. Examples include respiratory therapy and anesthesia equipment, some endoscopes, cystoscopes, and laryngoscope blades.

3) Noncritical items are items that have contact with intact skin but not mucous membranes and are associated with little risk of spreading germs. Noncritical items require at least low-level disinfection. Noncritical care items include bedpans, blood pressure cuffs, blood glucometers, crutches, and computers. Noncritical environmental surfaces include bed rails, tray tables, bedside tables, walls, floors, toilets, sinks, and furniture.

Tools and Resources

Ambulatory surgical centers

• Endoscope reprocessing toolkit (ASC Quality Collaboration)
• Environmental infection prevention toolkit (ASC Quality Collaboration)
• Single-use device reprocessing toolkit (ASC Quality Collaboration)
• Sterilization and high-level disinfection toolkit (ASC Quality Collaboration)

Checklists for monitoring compliance with cleaning practices

• CDC toolkit – options for evaluating environmental cleaning
• Environmental Checklist for Monitoring Terminal Cleaning
• Environmental cleaning evaluation worksheet
• VDH environmental cleaning checklist (Summer 2011)
• VDH environmental cleaning checklist for blood spills (Summer 2011)

Environmental Protection Agency (EPA)

• Actively registered hospital disinfectants products
• Guidance for the efficacy evaluation of products with sporicidal claims against Clostridium difficile
• Registered sterilizers, tuberculocides, and antimicrobial products against certain human public health bacteria and viruses

Fact sheets

• Environmental cleaning FAQ for assisted living facilities and nursing homes
• General environmental cleaning FAQ

Guidelines for Environmental Infection Control in Healthcare Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).  June 6, 2003. MMWR.

Indiana State Department of Health HAI Prevention Education Module – Course 1: Environmental Cleaning

• Online module (English) (Spanish)   
• Leader’s guide (English) (Spanish)

Not Just a Maid Service – Film developed by the Illinois Department of Public Health and the Illinois Quality Improvement Organization that highlights the role of environmental service workers in the prevention of Clostridium difficile infection.

Premier Safety Share, Bulletin: CDC releases 2008 guidelines for disinfection and sterilization.  Bleach dilutions clarified with household measurement terms, November 24, 2008.

Rutala WA, Weber DJ, et al., and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.