Infection Control Today - 02/2003: Environmental Services

First Impressions Start With Public Areas

By Jim Henry, CHESP

The old adage, "You only get one chance to make a good first impression," is true; nowhere is it more important to make a good first impression than in a healthcare facility. A good place to start is in the cleaning and disinfection of public areas.

 This policy:

  • Reassures visitors that their loved ones are in good hands
  • Influences every employee who walks through the door by improving their attitude while working in a clean environment
  • Influences regulatory inspectors who check the cleanliness of these first-impression areas.

Creating that first impression begins as visitors leave their cars and walk to the entrance of your building. Cleaning of this area should include regular sweeping of the parking lots and garage. Are the waste receptacles well placed and attractive?

Jay Grooten, regional training manager for Crothall Healthcare Inc., who started his career working for Walt Disney World, shared some interesting facts around a guest service measurement (GSM) conducted by Disney that measured how long people are willing to carry trash before they drop it on the ground. Most people will walk 19 steps or about 50 feet to find a trash can. That is valuable information when it comes to making sure you have enough receptacles to maintain a clean entrance to your facility. It is recommended that environmental services personnel check with the local fire department to determine if the receptacles inside the hospital building must meet a specified fire rating.

Are the sidewalks clean and free of debris? Does the entrance area need scrubbing or pressure washing to remove traffic patterns or gum? Are the windows and doors cleaned regularly? Here are a few recommendations that might help you be better prepared to create a good first impression. Use live, seasonal plants planted along the sidewalk and in planters located in the lobbies to give the image that this is an organization full of life. I would argue against using artificial plants or plants in need of maintenance, as this tends to create a negative image. Have the department responsible for maintaining the grounds and entrances have someone walk all entrances before 8 every morning to see what your visitors and staff will be seeing. Also, look to see if there are cigarette butts lying around or swept into the grass or plants around your entrances.

Once the guest enters your building, do the lobbies, hallways, elevators and restrooms sparkle? There are four different levels of cleaning needed in public areas to create a wonderful first impression and make sure it is free of germs.

The first is a good floor-care program. One of the first things noticed by people as they enter a building is how clean and shiny the floors are. Make sure the floor looks great. If the lobby has carpet, it needs to be spot free. If it has a tile floor, then make sure it is well maintained and has a deep shine. Remember to pull the furniture away from the walls to clean underneath on a regular basis; as guests sit down, they will notice dust and trash overlooked by the cleaning crew. Straw brooms are not recommended for use in a healthcare setting, due to the difficulty of cleaning the broom. Dust mops are the most commonly used broom in the healthcare industry. When mopping the floor, a neutral cleaner will prolong the life of the finish. However, when cleaning up a potentially infectious substance, you should always use a germicidal detergent.

The second level is a weekly deep cleaning (or detail cleaning) that includes high dusting of all surfaces 6 feet above the floor. Personnel should wipe all pictures, clocks and window seals, and check high corners for cobwebs. Because dust carries germs, it is recommended that a high-dust mop be saturated in a bucket of germicidal detergent and wrung out prior to being placed on the high-dust tool to help absorb the dust into the mop. Feather dusters are not recommended, as they do not hold the dust particles but simply move the dust from one surface to another.

Window seals and blinds should also be dusted weekly. To clean plastic horizontal blinds, close the blinds completely and using the same procedure with the high-dust tool, start at the top of the blind and move from side to side working your way down to the bottom of the blind. Once one side has been dusted, open the blinds completely to expose the other side and clean using the same procedure. Make sure to open the blinds so each slat will be able to dry.

Cleaning of windows should be done during daylight hours, as streaking is much more visible in the sunlight. Large windows should be cleaned using a squeegee method to speed up the process.

This level of cleaning is also responsible for all wall-washing of spots. It is imperative to use the manufacturer's recommended procedure and chemical(s) so there is no bleaching out or damage to the walls. When cleaning a painted surface, use a mild cleaner and water solution. It is best to pick an area of the wall that is not noticeable to conduct a test to see how the chemical will affect the surface of the wall. Stains or spots that cannot be removed should be reported to the appropriate department for repainting or replacement of the wall covering.

The third level of cleaning is the daily cleaning that includes the wiping of all surfaces 6 feet below and sweeping and mopping the floors. This level of cleaning includes the emptying and relining of trashcans. Trashcans that do not use liners should be cleaned using a germicidal detergent. Environmental services personnel should also straighten magazines and clean doors. Countertops, phones, water fountains, trashcans and most lobby furniture can be cleaned using a mild germicidal detergent. Wood furniture can be sealed with a furniture polish.

The fourth level of cleaning is sometimes referred to as "policing the area." This cleaning procedure is completed several times a day and involves walking through an area looking for magazines that may need straightening, picking up trash that might be on the floor and cleaning up small spills. Personnel should also clean the doors and immediate area outside the entrances. Usually this area is the sidewalk within a radius of 15 feet or to a curb if the roadway is close by.

Some organizations have been successful implementing an "adopt an area" program that incorporates the assistance of employees from a nearby department to help by completing the fourth level of cleaning. Organizations with these programs have reported employees taking ownership of an area and in many cases there is an increase in pride, as employees enjoy decorating their adopted areas for the various holidays.

When it comes to cleaning elevator cabs, the first thing noticed by most visitors is the condition of the floor. Make sure to detail the corners and edges and take time to clean out the door tracks. Remember that every floor has an elevator track, not just the cab. Use the same procedure for cleaning the wall coverings as in the lobbies. Clean the elevator buttons with a germicidal detergent.

Restrooms are often the one area by which visitors judge the cleanliness of the entire facility. It is imperative that rounds are completed often enough to keep up with the usage of the restroom. Some areas may require being checked every half hour or hour, whereas other areas may be able to go several hours between cleanings. In choosing dispensers for the restrooms, keep in mind the anticipated usage of the restroom and install the appropriate size of dispenser to keep up with the demand. This will help control your labor costs needed to constantly refill smaller dispensers.

There is no difference between policing and cleaning a restroom. During each cleaning, all surfaces and each stall should be cleaned thoroughly using a germicidal detergent. The floor should not be dust mopped, as this will contaminate your dust mop and require changing after every restroom. Simply using a wet mop and germicidal detergent is sufficient.

Many organizations have incorporated the help of the staff and public to help notify the appropriate personnel should the restroom need any attention by placing a well-written sign or tent card in each restroom. "If this restroom doesn't meet your expectations, then it doesn't meet ours. Please go to any phone and dial "CLEAN" to report any deficiencies."

By making rounds at all the entrances and checking the lobbies and restrooms on a regular basis, you will be positioning your team to be one step ahead of the general public and therefore able to create a good first impression.

Jim Henry, CHESP, is regional manager of Crothall Healthcare Inc. in Wayne, Pa.

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