Dealing with Dust

Cleaning Patient Rooms: Overcoming Everyday Obstacles

By Tina Brooks

Routine cleaning and removal of soil from environmental surfaces in patientrooms is an accepted practice; however, accomplishing this task on a daily basismay be difficult for environmental services personnel, especially when the roomis occupied.

Cleaning personnel face several challenges that can compromise theeffectiveness of their cleaning.

"First of all, the severity of patient illness sometimes makes itdifficult to do thorough cleaning," says infection control consultant MaryBrachman, RN, MS, CIC. "It is a very busy environment -- the number ofdoctors, nurses and the amount of hands-on care that is being delivered -makesaccess to the patient's bedside difficult."

The amount and complexity of medical equipment also can impede access tosurfaces, particularly those most likely to be contaminated. Often,environmental service personnel must maneuver around ventilator tubing, EKGwires, IV pole and tubing that goes over the bedrail. "It is compounded bythe fact that in some hospitals we tell cleaning personnel not to touch thepatient's medical equipment," says Brachman.

Another challenge includes family and privacy issues. To reduce the amount ofdisturbance placed on patients and visitors, Brachman recommends cleaning theroom in an organized fashion, moving logically from one area to another andworking as quietly as possible. Of course, being pleasant, using discretion onwhen to clean and showing respect for a patient's privacy are other means tolessen disturbance, she says.

Brachman mentions further that surfaces frequently get recontaminated afterhousekeeping has cleaned the patient's room.

"The bedrails can become contaminated by the gloved hand of thehealthcare worker during the course of the day,' she says.

Holding someone accountable for cleaning poses yet another challenge. Perhapscertain surfaces have never been clearly identified as the responsibility of anindividual 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 ofcleaning products used, e.g. quats, phenolics or chlorine.

"It is the cleaning process that is critical," she says. "Itdoesn't matter what product you use, if you haven't done some of the otherthings we've talked about - use appropriate type and concentration ofdisinfectant, identify the key surfaces needing cleaning and the frequency ofcleaning, establishing accountability, training and monitoring compliance. Toreduce infection risk, cleaning practices should focus on high-hand contactsurfaces 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:

--Tina Brooks