Cleaning Patient Rooms: Overcoming Everyday Obstacles
By Tina Brooks
Routine cleaning and removal of soil from environmental surfaces in patient rooms is an accepted practice; however, accomplishing this task on a daily basis may be difficult for environmental services personnel, especially when the room is occupied.
Cleaning personnel face several challenges that can compromise the effectiveness of their cleaning.
"First of all, the severity of patient illness sometimes makes it difficult to do thorough cleaning," says infection control consultant Mary Brachman, RN, MS, CIC. "It is a very busy environment -- the number of doctors, nurses and the amount of hands-on care that is being delivered -makes access to the patient's bedside difficult."
The amount and complexity of medical equipment also can impede access to surfaces, particularly those most likely to be contaminated. Often, environmental service personnel must maneuver around ventilator tubing, EKG wires, IV pole and tubing that goes over the bedrail. "It is compounded by the fact that in some hospitals we tell cleaning personnel not to touch the patient's medical equipment," says Brachman.
Another challenge includes family and privacy issues. To reduce the amount of disturbance placed on patients and visitors, Brachman recommends cleaning the room in an organized fashion, moving logically from one area to another and working as quietly as possible. Of course, being pleasant, using discretion on when to clean and showing respect for a patient's privacy are other means to lessen disturbance, she says.
Brachman mentions further that surfaces frequently get recontaminated after housekeeping has cleaned the patient's room.
"The bedrails can become contaminated by the gloved hand of the healthcare worker during the course of the day,' she says.
Holding someone accountable for cleaning poses yet another challenge. Perhaps certain surfaces have never been clearly identified as the responsibility of an individual or there has been a break in communication on accountability. Although the solution to these challenges may vary from hospital to hospital, Brachman offers the following suggestions to overcome them:
- Develop a team approach to cleaning, including representatives from environmental services, nursing and infection control.
- Achieve consensus on the role of the environment in the spread of infection. The risk may vary according to the type of hospital and patient population.
- Identify what surfaces get contaminated and when contamination is likely to occur.
- Determine the frequency of cleaning for each surface. Also, look at what methods will be used to clean the surfaces, including the types of disinfectants and cleaning practices.
- Identify who is responsible for cleaning specific surfaces. In some areas, cleaning may have to be a shared responsibilitywith nursing personnel since housekeeping typically cleans rooms only on a daily basis and surface recontamination may occur during patient care. Some hospitals have placed a ready-to-use disinfectant in areas where surface contamination is frequent, e.g., ICU so it would be convenient for patient care aids and nurses to use when surface contamination occurs.
- Educate personnel on the role of the environment in the spread of infection, proper cleaning methods and the healthcare workers' responsibilities to reduce risk of infection.
- Monitor compliance. Compliance monitors may include training, appropriate disinfectant use (type and concentration) and appropriate surfaces cleaned. Some hospitals measure the frequency of hospital-acquired methicillin resistant Staphylococcus aureus (MRSA) or vancomycin resistant enterococcus (VRE) as a surrogate for proper cleaning practices. One must use caution when drawing conclusions about cleaning practices using this monitor because other factors such as severity of patient illness, antibiotic use, barrier precautions and hand hygiene may be contributing factors.
Brachman warns not to mistakenly put too much emphasis on the type of cleaning products used, e.g. quats, phenolics or chlorine.
"It is the cleaning process that is critical," she says. "It doesn't matter what product you use, if you haven't done some of the other things we've talked about - use appropriate type and concentration of disinfectant, identify the key surfaces needing cleaning and the frequency of cleaning, establishing accountability, training and monitoring compliance. To reduce infection risk, cleaning practices should focus on high-hand contact surfaces as these surfaces may be the source of cross contamination."
Dealing with Dust
Keeping dust to a minimum is the concern of many in healthcare facilities. Dust can contain microorganisms such as Aspergillus, a mold that can cause infection in immune compromised patients. However, there are steps that can be taken to reduce the amount of dust present in patient rooms: