Infection Control Today - 07/2002: First Line of Defense

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First Line of Defense: Cleaning Patient Rooms

By Kathryn Dix

In the hubbub of modern medical technology, it's easy to forget the basics. Sometimes we need a reminder not to ignore the first line of defense -- cleaning the patient's personal space.

A telephone can carry up to 100 times more bacteria than a toilet bowl, but that doesn't necessarily mean that the toilet bowl is cleaner. According to a study1 by the University of Arizona's Dr. Charles Gerba, bacteria easily gather at American workspaces. If offices contain this much bacteria (a desk can harbor 400 times more bacteria than the average toilet seat), how many more germs can be lurking in a hospital filled with sick people?

When it comes to patient rooms, every surface is potentially swarming with bacteria, which is why it is crucial to follow cleaning guidelines to the letter. But sometimes even the guidelines leave out important cleaning policies.

Common items that may not be high-tech but can be forgotten include telephones, says Anthony Trombetta, education and training manager at the International Sanitary Supply Association (ISSA). Other areas that may be overlooked include door handles, bed frames and soap dispensers.

Trombetta has several guidelines for cleaning personnel. "One of the most important elements in keeping patient rooms clean is to make the patient's stay as pleasant as possible, by performing your work as quickly and efficiently as possible without sacrificing quality, and with a great attitude," he recommends.

Trombetta notes that certain procedures should always be incorporated into cleaning patient rooms.

  • Thoroughly wash your hands and wear impervious gloves as well as other safety items as your supervisor may instruct.
  • Stock all of the items that you will require on your custodial cart before you begin.
  • Wait for all medical personnel including doctors and nurses to finish their work before you begin.
  • Leave your custodial card outside of the patient room (be sure not to block any doors or emergency exits).
  • Never spray cleaner directly on surfaces as this may cause damage.
  • Be careful not to lean on, bump or disturb the patient bed.
  • Anything you learn or hear about a patient should be kept strictly confidential.

Custodial Procedures

  • Empty trash, clean basket and replace liner.
  • Perform high dusting by starting at the top and working down.
  • Place wet floor signs on the floor and dust-mop entire floor.
  • Clean all furnishings, fixtures and spot clean walls.
  • Clean patient restroom.
  • Wet or damp mop entire floor surface.
  • Inspect work and remove wet floor signs.

With the advent of managed care, there are always concerns about expenses. There are ways to control or reduce costs, Trombetta says. One suggestion is to use an approved dilution control system. Also, properly train employees to improve morale and reduce turnover.

Although cleaning staff does undergo some form of training before beginning their duties, Trombetta says there is always room for improving processes and job performance. "Employee attitude and appearance can play a significant role in improving performance perception," he adds. "Education is key, especially in a hospital setting. Careful attention to safety, set-up, proper usage of cleaning chemicals and product application are important as well."

Yale-New Haven Hospital's online infection control manual2 has multiple guidelines for cleaning patient rooms. These, like other hospitals' guidelines, are basic common sense combined with scientific advances in protection and in cleaning solutions. Yale-New Haven's manual recommends that walls, floors and countertops be cleaned with EPA-approved disinfectants. In addition, gloves should always be worn, with other barrier protection worn as necessary.

Handwashing is crucial and should be performed before cleaning, after contamination, after removing gloves and after cleaning.

Floors should be damp-mopped each day, and waste receptacles should be emptied as needed and no less than once a day. Other daily tasks include cleaning bathrooms (with particular attention to the commode, sink, faucet handles and door knobs). Soap dispensers should be refilled as needed. However, no mention is made of the cleaning of the soap dispenser -- the handle of which may have come into contact with the patient or healthcare workers (HCWs) frequently.

Walls and curtains should be cleaned periodically, or when soil becomes visible. And cleaning cloths and mop head should be reprocessed each day by the environmental services department.

For terminal cleaning of patient rooms, tasks should also include disinfection of the bed frame, mattress, pillow and all other room furniture with an EPA-approved disinfectant; the disposal of all opened and/or contaminated non-reusable items; removal of suction containers for reprocessing or disposal, return of reusable equipment that requires disinfection and/or re-sterilization to CSS for reprocessing; and decontamination of all reusable clinical equipment.

Yale-New Haven does not require that employees discard soap in dispensers and rolls of toilet paper. Cleaning in any airborne/droplet precaution rooms is identical to that of other rooms, but the hospital recommends that HCWs should add a N-95/HEPA respirator to the standard barrier protection attire if the patient has suspected or confirmed pulmonary TB. If the patient is on droplet precautions, a surgical mask is adequate.

The University of Utah3 has similar recommendations, but also adds the following for discharged patient rooms:

  • Replace soap and paper products
  • Empty and dispose of bedpans, colostomy bags, emesis basins, plastic washbasins, soiled potty chairs, urine measuring hats and urinal receptacles.

For occupied patient rooms, the university recommends that unit staff clean the bulk of spilled body fluids, empty the bedpans, colostomy bags, etc., and that they replace and add isolizer to expanded body substance suction canisters.

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