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

First Line of Defense: Cleaning Patient Rooms

By Kathryn Dix

Inthe 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 -- cleaningthe patient's personal space.

A telephone can carry up to 100 times more bacteria than a toilet bowl, butthat doesn't necessarily mean that the toilet bowl is cleaner. According to astudy¹ by the University of Arizona's Dr. Charles Gerba, bacteriaeasily gather at American workspaces. If offices contain this much bacteria (adesk can harbor 400 times more bacteria than the average toilet seat), how manymore germs can be lurking in a hospital filled with sick people?

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

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

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

Trombetta notes that certain procedures should always be incorporated intocleaning 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 touse an approved dilution control system. Also, properly train employees toimprove morale and reduce turnover.

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

Yale-New Haven Hospital's online infection control manual² hasmultiple guidelines for cleaning patient rooms. These, like other hospitals'guidelines, are basic common sense combined with scientific advances inprotection and in cleaning solutions. Yale-New Haven's manual recommends thatwalls, floors and countertops be cleaned with EPA-approved disinfectants. Inaddition, gloves should always be worn, with other barrier protection worn asnecessary.

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

Floors should be damp-mopped each day, and waste receptacles should beemptied as needed and no less than once a day. Other daily tasks includecleaning bathrooms (with particular attention to the commode, sink, faucethandles 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 whichmay have come into contact with the patient or healthcare workers (HCWs)frequently.

Walls and curtains should be cleaned periodically, or when soil becomesvisible. And cleaning cloths and mop head should be reprocessed each day by theenvironmental services department.

For terminal cleaning of patient rooms, tasks should also includedisinfection of the bed frame, mattress, pillow and all other room furniturewith an EPA-approved disinfectant; the disposal of all opened and/orcontaminated non-reusable items; removal of suction containers for reprocessingor disposal, return of reusable equipment that requires disinfection and/orre-sterilization to CSS for reprocessing; and decontamination of all reusableclinical equipment.

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

The University of Utah³ has similar recommendations, but also addsthe 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 cleanthe bulk of spilled body fluids, empty the bedpans, colostomy bags, etc., andthat they replace and add isolizer to expanded body substance suction canisters.