Best practices for disinfecting your facility if you handle hazardous waste have been designed to provide local, state, and federal waste management entities information on the process. These best practices outline methodologies and techniques which will improve the handling and management of hazardous waste.
Best practices of disinfecting for healthcare facilities reduce or eliminate the chances of environmental contamination that is significantly linked with the transmission of pathogens responsible for major outbreaks. Investigations of outbreaks have shown the risk of patient colonization, and infection substantially increases if a patient is placed into a room previously used by an infected person.
Disinfecting this room is imperative to stop the spread of bacteria. All surfaces within the patient zone must be disinfected to prevent another person from becoming infected. The patient zone includes all areas frequently touched by physical contact, such as the bedside tables, chairs, bed rails, and any other surfaces the infected patient touched or could have touched.
Best Practices and Environmental Cleaning in Healthcare
An environmental cleaning program consists of interventions or a set of elements used to implement this type of cleaning program within a facility. These programs require a standardized approach along with strong management from multiple departments within the healthcare facility, such as IPC, facilities management, or administration.
- Environmental Cleaning– Environmental disinfection and cleaning of environmental surfaces refer to such areas as call buttons, chairs, mattresses, bed rails, and other surfaces that were or could have been touched by the patient. Also surfaces of noncritical patient care, such as stethoscopes, IV poles, etc.
- Patient Care Areas– Patient care areas include any area where a patient has directly been provided care. These areas include examination rooms, medication preparation areas, toilet areas, and any other areas within specialized and general patient care areas.
- Healthcare Facilities– Healthcare facilities consist of both in-patient and out-patient settings. It includes all tiers of health care from tertiary care to primary care and those who manage cleaning activities, whether contracted or by internal cleaning services.
Disinfecting, or cleaning programs, in a healthcare facility, involves engagement from the various departments mentioned and can vary depending on the size of your facility.
No matter which type of healthcare facility you have, the main elements needed for effective environmental disinfecting programs will remain the same:
- The support that is organized
- Staff needs to be adequately trained
- Wastewater and water services, equipment and supplies (supporting infrastructure)
- Procedures and policies in place to be followed
- Feedback and monitoring systems
Environmental cleaning requires you to have sufficient quantities of water. This water supply is going to generate almost as much wastewater. The wastewater will have to be disposed of appropriately and safely, so there is no contamination of the environment and your surrounding community.
Communication is Essential Best Practice for Disinfection Program
For an environmental disinfecting program to be effective, you need strong communication along with collaboration across various levels of your facility. Having a strong communication system will improve the understanding of how important it is to perform environmental cleaning for both patient safety and that of the staff. Your communication structure should establish:
- A committee consisted of the facility’s staff, such as a representative of the clinic’s staff, and an IPC committee member. If there is more than one ward in your facility, then one representative from each ward should be included in the committee, as well as one from the administration.
- The committee should have routine meetings to facilitate regular communication between the cleaning program manager and the other members of the committee. It is recommended to conduct these meetings monthly.
- The cleaning program manager and the committee will review and update any necessary technical aspects of the disinfecting and cleaning processes in place.
Supervision and Management for Disinfecting Best Practices
To have an effective environmental disinfecting and cleaning program, you need a defined management structure. This structure should include on-site supervision, along with organizational and reporting lines. The elements for this structure include:
- Organizational chart– An organizational chart to outline the reporting lines between your cleaning staff, managers, and any indirect or direct relationships, such as the ward-in-charge staff or facility IPC.
- Supervision– You should have an on-site supervisor for cleaning staff to make sure compliances to best practices are being met. This supervision should include direct monitoring along with feedback that ensures consistent availability of equipment and cleaning and disinfecting supplies. The cleaning staff should also communicate to supervisor any challenges or concerns they are experiencing regarding compliances such as safety concerns or supply shortages.
Best Practices Staffing Elements
Key elements to your program include appropriate staffing levels along with proper training and education. Your cleaning staff should always be a paid position which includes:
- Terms of reference or written job descriptions
- Targeted training sessions that include pre-service training and whenever new equipment is introduced
- Staff should always have easy access to an on-site supervisor to ensure they are able to perform their duties safely
Best practices state your cleaning staff should:
- Understand and be familiar with job description and what is expected in performance standards
- Staff should only be asked to perform duties that they have been trained to perform. Staff should never be asked to clean high-risk patient zones unless they’ve received the specific training for those areas
- Staff should be trained to identify hazards of chemicals they can be exposed to in their workplace
- There should always be appropriate and sufficient supplies of equipment and PPE necessary for staff to perform their duties
- Staff scheduling should include consistent working shifts with acceptable norms
One of your most important factors for establishing an effective environmental cleaning and disinfecting program is to have adequate staffing. If your facility is small and has limited patient services, your cleaning staff could include part-time positions or be incorporated with other services, such as laundry. If your facility is large, such as a hospital, you will need a full-time dedicated cleaning and disinfecting staff.
Best Practice Training and Education for Staff
Your cleaning staff should be trained according to environmental cleaning policies under national guidelines or the healthcare facility. Training should be completed before the staff is allowed to work independently within your healthcare facility. At a minimum, your training should include:
- Introduction to the principles of IPC, which provides for how pathogens are transmitted, and their role in keeping patients, visitors, and staff protected from those pathogens
- Staff should be trained on the specific environmental cleaning tasks for which they will be responsible for, including checklists and a review of SOPs
- Training should include how to safely prepare and use disinfectants, detergents and other cleaning solutions
- Training should be completed on how to apply, reprocess and store disinfecting and cleaning supplies and equipment, including personal protection equipment
- The methods shown on how to perform their duties should include demonstrations along with hands-on trials
- There should be visual reminders on procedures that are clear and do not require a lot of reading. Staff should be aware of these signs and their meanings
Your training sessions should be conducted according to the intended audience. Staff should not have to sit through training that will not pertain to their daily duties. The content of the training sessions should be tailored specifically to the cleaning staff for which their cleaning responsibilities will include.
Periodic competency assessments should be scheduled along with refresher training. You should also ensure there is proper training scheduled anytime new equipment is introduced into the program.
Equipment and Cleaning Supplies for Environmental Disinfection
It is critical to select the appropriate equipment and supplies for effective environmental cleaning in patient care zones. Best practices for choosing disinfectant equipment and supplies includes using the right disinfectant products, reusable and disposable supplies, and PPE (personal protective equipment) for all staff.
Having the proper equipment and supplies is as important as implementing standard operating procedures for patient zones. Based on risk assessment, best practice should include overall techniques and strategies for how environmental cleaning is performed.
Selecting appropriate disinfecting and cleaning supplies and your equipment is critical for your cleaning program. It is also essential to your program that you effectively manage the upkeep, procurement, and maintenance of your equipment and ensure there are no stock-outs of your supplies.
Best practices for equipment and supply management include:
- Create a master list of all equipment and supplies, which includes supplier information and detailed specifications, such as required quantities that should always be on-hand
- Create a regular schedule to inspect inventories of supplies to prevent stock-outs, ensure availability of materials, and anticipate supply needs
Your facility should also have a team assigned to make sure all furniture, finishes, and patient care zones are adequately cleaned and disinfected.
Cleaning Policies to Meet Best Practice Program
Best practice environmental cleaning policies provide a standard for which your facility needs to perform in order to meet the required elements. If your facility is using an outside service for disinfecting and cleaning, these policies can be used to develop your contract for their services:
- All implicated staff needs a line of accountability and responsibilities
- Cleaning schedules need to be created for every patient care zone along with noncritical patient care equipment
- There should be a contingency plan in place for required cleaning procedures for hazardous outbreak management or environmentally hardy organisms
- Training is required for performance standards of the cleaning staff
- Monitoring of methods, which involves the frequency of those methods, and staff responsible for methods
- Create a list of approved supplies for both cleaning and disinfecting purposes and the equipment, including how equipment is used
- Create a list of all necessary personal protective equipment along with notation of when hand hygiene action is required by staff
When developing your facility’s policies, it is recommended to consult with governmental policies to ensure all standards for healthcare environmental cleaning and disinfecting are being met. You can also contact Environmental Marketing Services, LLC for advice and help in establishing appropriate programs.