Cleaning Basics Module 1

Cleaning Basics Module 1.

[Audio] Please review the objectives for this course. Upon completion, 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..

[Audio] Good Shepherd Health Care System is committed to providing a safe and healthy work environment for our staff. The Occupational Safety and Health Administration (OSHA) regulates the bloodborne pathogens standard to protect all healthcare works from exposure to germs that can be spread in blood and body fluids. The GSHCS Bloodborne Pathogen Exposure Plan (https://gshealth.policystat.com/policy/13081957/latest/) aligns with the OSHA standard 25 CFR 1910.1030, Occupational Exposure to Bloodborne Pathogens..

[Audio] Gloves, gowns, masks, hoods, PAPR and eye protection are available to all employees. The type of personal protective equipment indicated for use is determined by the procedure or task being performed and the potential for exposure to blood or other body fluids. Surgical and Environmental Services are both considered high-risk areas for potential exposure..

[Audio] Gloves are an essential component of Standard Precautions. Team members must: Wear clean gloves for anticipated contact with blood, body fluids (including open or draining wounds, secretions, excretions, when touching mucus membranes and non-intact skin), and when touching contaminated or soiled equipment, Remove gloves promptly, discard after use, and immediately clean hands before touching non-contaminated items (eg, computer keyboard), when leaving the room, or seeing another patient, Gloves should never be re-used, Gloves do not replace the need to clean hands. https://gshealth.policystat.com/policy/13832597/latest.

[Audio] Team members must also wear face (mouth/eye) protection such as masks, goggles, or masks with face shield attached if there is a risk of exposure by splashes, sprays, splatters or droplets of blood or other bodily fluids. This will reduced the employee's risk of exposure to bloodborne pathogens and other potentially infectious materials..

[Audio] This table is taken from the GSHCS Bloodborne Pathogen Exposure Plan and shows the minimum PPE requirements based on the activity being performed. Though very beneficial, this list may not be all-inclusive and judgement is required on the part of the staff member to assess the need for additional protective equipment. Please contact the Infection Prevention staff at extension 3639, your supervisor or charge nurse if you have any questions or concerns about what PPE is necessary for your specific task at hand..

[Audio] Hand hygiene is the first line of defense to stop the spread of infection. Lack of proper hand hygiene can not only potentially infect the personnel, patients are also at risk if a microorganism is on their hands. There are two forms of hand hygiene, soap and water or an alcohol-based hand sanitizer. To use soap and water, rub your hands with soap for at least 20 seconds before rinsing off with warm (not hot) water. Be sure to scrub all areas of the hands including between fingers, under nails, front and back of hands. To use an approved alcohol-based hand sanitizer you need to use enough product to visibly wet the hands both front and back. Rub the hands together including all areas including between fingers, under nails, front and back of hands. Rub until hands are dry..

[Audio] The bloodborne pathogen exposure plan defines when to use alcohol-based hand sanitizer versus when you need to wash your hands with soap and water. Review this slide to learn which type of hand hygiene to use..

[Audio] The next several slides are a quick review of the definitions for frequently used terminology. Clean is the absence of visible dust, soil, debris, or blood Disinfection is the process that kills pathogens and other microorganisms by physical or chemical means..

[Audio] High-touch objects are those objects and surfaces that frequently touched. High-touch objects and surfaces will be discussed in more detail later in the course. Dwell time is the amount of time a chemical agent must remain "wet" on a surface to remove the bioburden. The current product being used is Micro-Kill Q3 Disinfectant has a three (3) minute dwell time and is a one-step cleaner and disinfectant.

[Audio] Terminal cleaning and disinfection of operating and procedure rooms occurs at the end of each day the room or area is used. Between each patient cleaning. This may also be referred to as end of procedure cleaning or turn over. This is the cleaning and disinfection of the operating or procedure room when the patient leaves the room and prior to the next patient entering the room. This process occurs multiple times throughout the day..

Definitions. Scheduled cleaning This is cleaning of areas and surfaces not addressed in the previous types of cleaning, for example: walls and ceilings, storage areas and ventilation ducts.

[Audio] In the operative and 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..

[Audio] 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. The links include: Microorganisms can be a bacteria, virus, fungus, or parasite. Reservoir/Source is the habitat for the microorganism to grow, there can be any number of reservoirs such as humans, animals, soil, water, food, surfaces and equipment. Portal of Exit is how the microorganism leaves the or exits the reservoir Mode of Transport is how the microorganism travels from the reservoir to the susceptible host this can be through contact, droplets, airborne, vectors such as mosquitoes or fleas, and fomites which could include food, water, Portal of entry is point of entry for the microorganism to enter the body, such as a surgical incision, open wound, mucus membranes, respiratory or urinary tract Susceptible host could be those patients with extremes in age, very young or very old, those with chronic diseases, malnourished or immunocompromised.

[Audio] By targeting and breaking 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). Every patient should be provided with a clean, safe environment..

[Audio] 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..

[Audio] These items are not located 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 EVS 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..

Decisions about Cleaning Products. Risk Assessment.

[Audio] As previously reviewed, there are five types of environmental cleaning used in the perioperative areas, which include damp dusting, between-patient cleaning or turn-over, terminal cleaning, enhanced environmental cleaning and scheduled cleaning..

[Audio] Damp dusting may be done by either surgical services personnel or environmental services staff. Damp dusting occurs at the beginning of the day and prior to any equipment, cart, supplies or patients being taken into the room and includes removing dust from all horizontal surfaces..

[Audio] This type of cleaning is sometimes referred to as "turn-over cleaning." During room turn-overs or between patient cleaning, 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. Staff are also responsible for ensuring all trash and soiled linens have been removed from the room..

[Audio] 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..

[Audio] Please review this slide for list of high-tough objects and surfaces. These are examples and not an all-inclusive list..

[Audio] Here is an example of when surfaces and equipment need to be cleaned in the operating or procedure room. The purple handprints are those surfaces that are cleaned between every patient, this includes but is not limited to the OR table, anesthesia cart, IV poles and pumps and the monitor. The lavender hand are those surfaces and objects that need to be cleaned between every patient only if they have used or are soiled. This could include the overhead lights, mayo stands, and the boom. The yellow handprint signifies those areas that are included in enhanced cleaning and disinfecting, these surfaces are in addition to the previously mentioned surfaces and equipment. Blue handprints are the surfaces that are cleaned when visibly soiled or according to the facility scheduled cleaning when not visibly soiled..

[Audio] To prevent the spread of microorganism during the cleaning and disinfecting process it is very important to follow a systematic approach. 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..

[Audio] This is an example of the surfaces that need to be cleaned in the day surgery, PACU and postoperative areas. Just like cleaning the operating and procedure rooms, there are surfaces that are cleaned between each patient, items that are cleaned only if used, surfaces and equipment that are cleaned if there has been an infectious patient in the room and those items that are cleaned only if soiled or are cleaned and disinfected on a schedule when not used..

[Audio] 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..

[Audio] When cleaning the sterile processing department (SPD), the same principles apply. Cleaning from top to bottom and cleanest to dirtiest. Thus cleaning begins in the sterile storage area – cleaning this area from top to bottom and cleanest to dirtiest, moving to the next designated area and ending in the decontamination area..

[Audio] Clean and disinfect the floors, remembering to start at the cleanest area and moving to the dirtiest. For the floors this generally means from the outer edge to the center. As you recall, cleaning from the cleanest area to the dirtiest prevents the spread of microorganisms. Dirty mop heads never go back in the mop bucket (water) as this would contaminate the water and promote the spread of microorganisms..

Cleaning Chemicals. [image] A poster with a green bottle and a spray bottle Description automatically generated.

[Audio] 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 Equipment. Cleaning equipment for semi-restricted and restricted areas Should be dedicated equipment Wheels on carts and other equipment can transfer soil from outside areas Using dedicated equipment for the semi-restricted and restricted areas may decrease the risk of cross-contamination from other areas in the hospital.

[Audio] Identify what types of cleaning tools and equipment your facility provides now. Talk through the processes used for disposal of the equipment once used..

References. Chain of Infection Components (04/28/2022) Biological Hazards. The National Institute for Occupational Safety and Health (NIOSH). Retrieved 01/30/2024 from https://www.cdc.gov/niosh/learning/safetyculturehc/module2/3.html Environmental Cleaning (2022). Guideline Essentials. Environmental Cleaning Tool Kit. Association of periOperative Registered Nurses (AORN). Retrieved 01/30/2024 from https://www.aorn.org/guidelines-resources/tool-kits/environmental-cleaning-tool-kit.