Fundamentals of Nursing Practice

RLE/Skills Lab
STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR
Session #01

LESSON TITLE: ENVIRONMENTAL CLEANING Materials:

LEARNING TARGETS: Book, pen and notebook
Upon completion of this lesson, the nursing student can: References:

1. Understand the importance of the environment in Environmental Cleaning Procedures. (2020, April
21). https://www.cdc.gov/hai/prevent/resource-
infection transmission. limited/cleaning-procedures.html.

2. Distinguish routine cleaning from terminal cleaning. Sam, A. (2017, January 7). Abdullah Sam.
https://notesread.com/hospital-cleaning-
3. Be familiar with procedures of damp dusting. procedures-and-methods/.

Dramowski, A. (2020). 6. Environmental cleaning,

waste management and decontamination of
medical devices.
https://bettercare.co.za/learn/infection-prevention-
and-control/text/06.html.

SUBJECT ORIENTATION (10 minutes)

The instructor will start to welcome the students, introducing first his/herself and orient the students of the following:
1. The course syllabus for the whole semester
2. Computation of their grades
3. Classroom rules and policies.
4. Any other concerns raised during the class.
Getting to know each other activity:
The students will now proceed to their self - introduction in a creative way. Each will be asked of their name, age, school
graduated and who they think is their look-alike (kaloka-like) or who inspires them and why did they choose Nursing as
their course. They will be given utmost 30 seconds each so everybody can participate.
Example: Good day! I am Liezl Mae Macaraeg, 18 years of age, graduated from Pangasinan School of Arts and Trades. I
think my kalook-alike is Kathryn Bernardo and I chose Nursing because it was my parents choice.
MAIN LESSON (80 minutes)
The following topics are the focus of today’s discussion. Fill out the needed information in your SAS as you go with your
lesson.
ENVIRONMENTAL CLEANING
Cleaning (in the healthcare setting) refers to the removal of visible dirt, dust and debris. Cleaning alone results in large
reductions in environmental contamination, including the removal of many pathogens. A clean patient environment
contributes to prevention of healthcare-associated infection. Cleaning in healthcare facilities aims to remove visible dirt
and dust, reducing levels of harmful micro-organisms in the patients’ surroundings. Dust contains skin scales and micro-
organisms, which can be spread in the environment and air by sweeping or dry dusting.
The determination of environmental cleaning procedures for individual patient care areas, including frequency, method,
and process, should be based on the risk of pathogen transmission.
This risk is a function of the:
1. probability of contamination
2. vulnerability of the patients to infection
3. potential for exposure (i.e., high-touch vs low-touch surfaces)

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These three elements combine to determine low, moderate, and high risk—more frequent and rigorous (with a different
method or process) environmental cleaning is required in areas with high risk. Risk determines cleaning frequency,
method, and process in routine and contingency cleaning schedules for all patient care areas.
Risk-Based Environmental Cleaning Frequency Principles
Probability of contamination: Heavily contaminated surfaces and items require more frequent and thorough
environmental cleaning than moderately contaminated surfaces, which in turn require more frequent and rigorous
environmental cleaning than lightly or non-contaminated surfaces and items.

Vulnerability of patients to infection: Surfaces and items in care areas containing vulnerable patients (e.g.,
immunosuppressed) require more frequent and rigorous environmental cleaning than surface and items in areas with less
vulnerable patients.
Potential for exposure to pathogens: High-touch surfaces (e.g., bed rails) require more frequent and rigorous
environmental cleaning than low-touch surfaces (e.g., walls).
Every facility should develop cleaning schedules, including:
 identifying the person responsible
 the frequency
 the method (product, process)
 detailed SOPs for environmental cleaning of surfaces and noncritical equipment in every type of patient care area
General environmental cleaning techniques
For all environmental cleaning procedures, always use the following general strategies:
 Conduct Visual Preliminary Site Assessment
Proceed only after a visual preliminary site assessment to determine if:
o patient status could pose a challenge to safe cleaning
o there is any need for additional PPE or supplies (e.g., if there are any spills of blood/body fluids or if the
patient is on transmission-based precautions)
o there are any obstacles (e.g., clutter) or issues that could pose a challenge to safe cleaning
o there is any damaged or broken furniture or surfaces to be reported to supervisor/management
 Proceed From Cleaner To Dirtier
Proceed from cleaner to dirtier areas to avoid spreading dirt and
microorganisms. Examples include:
i. During terminal cleaning, clean low-touch surfaces before high-touch
surfaces.
ii. Clean patient areas (e.g., patient zones) before patient toilets.
iii. Within a specified patient room, terminal cleaning should start with
shared equipment and common surfaces, then proceed to
surfaces and items touched during patient care that are outside of
the patient zone, and finally to surfaces and items directly
touched by the patient inside the patient zone. In other words, high-
touch surfaces outside the patient zone should be cleaned before the
high-touch surfaces inside the patient zone. Cleaner to Dirtier Cleaning Strategy
iv. Clean general patient areas not under transmission-based precautions before those areas under transmission-
based precautions.
 Proceed From High To Low (Top To Bottom)
Proceed from high to low to prevent dirt and microorganisms from
dripping or falling and contaminating already cleaned areas.
Examples include:
o cleaning bed rails before bed legs
o cleaning environmental surfaces before cleaning floors
o cleaning floors last to allow collection of dirt and
microorganisms that may have fallen
 Proceed in a Methodical, Systematic Manner
Proceed in a systematic manner to avoid missing areas—for
example, left to right or clockwise. In a multi-bed area, clean
each patient zone in the same manner—for example, starting
at the foot of the bed and moving clockwise. Methodical & Sytstematic Manner

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This is the general surface cleaning process:
1. Thoroughly wet (soak) a fresh cleaning cloth in the environmental cleaning solution.
2. Fold the cleaning cloth in half until it is about the size of your hand. This will ensure that you can use all of the
surface area efficiently (generally, fold them in half, then in half again, and this will create 8 sides).
3. Wipe surfaces using the general strategies as above (e.g., clean to dirty, high to low, systematic manner), making
sure to use mechanical action (for cleaning steps) and making sure to that the surface is thoroughly wetted to
allow required contact time (for disinfection steps).
4. Regularly rotate and unfold the cleaning cloth to use all of the sides.
5. When all of the sides of the cloth have been used or when it is no longer saturated with solution, dispose of the
cleaning cloth or store it for reprocessing.
6. Repeat process from step 1.
For all environmental cleaning procedures, these are the best practices for environmental cleaning of surfaces:
 Use fresh cleaning cloths at the start of each cleaning session (e.g., routine daily cleaning in a general inpatient
ward).
 Change cleaning cloths when they are no longer saturated with solution, for a new, wetted cloth. Soiled cloths
should be stored for reprocessing.
 For higher-risk areas, change cleaning cloths between each patient zone (i.e., use a new cleaning cloth for each
patient bed). For example, in a multi-bed intensive unit, use a fresh cloth for every bed/incubator.
 Ensure that there are enough cleaning cloths to complete the required cleaning session.
 Never double-dip cleaning cloths into portable containers (e.g., bottles, small buckets) used for storing
environmental cleaning products (or solutions).
 Never shake mop heads and cleaning cloths—it disperses dust or droplets that could contain microorganisms.
 Never leave soiled mop heads and cleaning cloths soaking in buckets.
High-Touch Surfaces:
The identification of high-touch surfaces and items in each patient care area is a necessary prerequisite to the
development of cleaning procedures, as these will often differ by room, ward and facility. Perform assessments and
observations of workflow in consultation with clinical staff in each patient care area to determine key high-touch surfaces.
Include identified high-touch surfaces and items in checklists and other job aids to facilitate completing cleaning
procedures. Common high-touch surfaces include:
 bedrails
 IV poles
 sink handles
 bedside tables
 counters where medications and supplies are prepared
 edges of privacy curtains
 patient monitoring equipment (e.g., keyboards, control panels)
 transport equipment (e.g., wheelchair handles)
 call bells
 doorknobs
 light switches
DAMP DUSTING
Routine cleaning is the standard, everyday procedure for cleaning of clinical areas, including mopping of floors, damp
dusting of surfaces with detergent, etc. Terminal cleaning is performed when a patient with a transmissible illness is
discharged (usually for isolation rooms), e.g. MRSA and other drug-resistant bacteria, tuberculosis, Clostridium difficile.
Damp dusting – method of dusting is employed in the care of hospital furnishings which are not upholstered, and for the
removal of dust from all surfaces above the floor.
Dangers of Dusts
Dust is a potent source of disease specially in hospital. Hospital contains sand particles coming inside by foot-wear or
blown in wind, scales from skin, dried infected matter like pus and other debris of wound, dried threat and nasal
secretions, particles of dried threat and nasal secretions. and food particles etc. As such various types of organism
and specially virulent types remain in dust. Therefore, dust can cause disease either by direct contact with wound, eyes,
nose, throat or by’ inhalation to lungs or it can contaminate food or water. So proper cleaning of dust becomes a major
part of nursing care.

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Types of Dusting:
1. Low Dusting – done to all places easily reached by standing on the floor; done daily.
2. High Dusting – refers to those areas over windows, pipes, wall and ceiling.
Rules for Cleaning
 Dry dusting is never advisable. It spreads  Dusting should be done without disturbing or
disease easily. removing the parents on bed.
 Dusting should be done after sweeping only.  Dusting should be done from top to bottom i.e.
 Use a damp duster for collecting dust. from upward Id downward direction.
 Dost with clean duster.  While dusting, take care not to spoil the beds or
 Collect dust at one place to avoid flying from walls other fixers in room or hospital ward.
place to place.  While dusting, wounds or dressing should not be
opened other staff.
 There should be a definite time for dusting daily.
Equipments: Order of dusting:
Tray with basin of water Beds
Several pieces of dusting cloth Bedside tables
Laundry soap/dutch cleanser Chairs
Bottle of mineral oil Wood works
Newspaper of glasses
Whisk broom
DAMP DUSTING
PROCEDURE RATIONALE
Assessment
Visual preliminary site assessment To determine if patient status could pose a challenge to
safe cleaning, there are any obstacles (e.g., clutter) or
issues that could pose a challenge to safe cleaning or if
there is any damaged or broken furniture or surfaces to
be reported to supervisor/management.
Preparation
Wear any needed PPE (e.g. masks, eye shield, gloves,
To observe transmission-based precautions.
apron, etc.)
Collect & bring supplies. To observe efficiency.
Implementation
Unvarnished Furniture:
Place your preparation at a convenient place on the table
or chair but not on the floor.
Thoroughly wet (soak) a fresh cleaning cloth in the
environmental cleaning solution.
This will ensure that you can use all of the surface area
Fold the cleaning cloth in half until it is about the size of
efficiently (generally, fold them in half, then in half again,
your hand.
and this will create 8 sides).
General strategies follow clean to dirty (to avoid
Wipe surfaces using the general strategies making sure to spreading dirt and microorganisms), high to low (prevent
use mechanical action and making sure to that the surface dirt and microorganisms from dripping or falling and
is thoroughly wetted to allow required contact time. contaminating already cleaned areas) and systematic
manner (to avoid missing areas).
Regularly rotate and unfold the cleaning cloth. To use all of the sides.
Never double-dip cleaning cloths into portable
Rinse the dusting cloth. containers (e.g., bottles, small buckets) used for storing
environmental cleaning products (or solutions).
Continue the procedure until all the parts have been
dusted.
Varnished Furniture:
If the furniture is varnished, do not used soap but dust only
with damp cloth and wipe dry.
Follow dusting with oiled cloth.
Wipe to dry.

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CHECK FOR UNDERSTANDING (20 minutes)
This will serve as a quiz for the students. 1 point is given to each correct answer and another point for the correct rationale
given per number. Superimpositions & erasure are not allowed.
Multiple Choice
RATIONALIZATION ACTIVITY (DURING THE FACE TO FACE INTERACTION WITH THE STUDENTS)
After the prescribed time, the correct answers and their respective rationale will be provided. You are encouraged to ask
questions if there are any.
1. What can a clean patient environment contribute?
A. Reduction in environmental contamination including removal of pathogens.
B. Prevention of healthcare-associated infection.
C. A & B
D. None of the above
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
2. A nurse is knowledgeable that a patient under her care in the isolation room will be discharged during her
shift. What type of cleaning will be performed?
A. Regular cleaning
B. Intensive cleaning
C. Routine cleaning
D. Terminal cleaning
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
3. This type of cleaning includes mopping of floors and damp dusting of surfaces with detergent.
A. Regular cleaning
B. Intensive cleaning
C. Routine cleaning
D. Terminal cleaning
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
4. This is a method of dusting is employed in the care of hospital furnishings which are not upholstered, and for
the removal of dust from all surfaces above the floor.
A. Dump dusting
B. Damp dusting
C. Low dusting
D. High dusting
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
5. This refers to dusting those areas over windows, pipes, wall and ceiling.
A. Dump dusting
B. Damp dusting
C. Low dusting
D. High dusting
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
6. This type of dusting is done to all places easily reached by standing on the floor; done daily.
1. Dump dusting
2. Damp dusting
3. Low dusting
4. High dusting
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________

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7. Why is it necessary for someone to wear appropriate PPEs even when cleaning?
A. PPEs are not necessary for cleaning as long as you are healthy.
B. To protect if there are any spills of blood/body fluids.
C. To prevent from being infected if the patient is on transmission-based precautions
D. B & C
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
8. As you clean a patient’s bed side table, what rationale would you keep in mind as you perform the cleaner-to-
dirtier method?
A. Minimize spread of microorganisms.
B. To save time
C. To save cleaning cloth
D. B & C
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
9. To prevent microorganisms from dripping and contaminating clean areas, what strategy should you observe?
A. Dirtier to cleaner strategy
B. High to low strategy
C. Bottom to top strategy
D. Methodical strategy
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________
10. You observe a colleague cleaning a patient’s room where she jumps from one area to another. What errors
could unfortunately happen?
A. None, since she is still cleaning the room.
B. She will easily get tired.
C. She is spreading the pathogens
D. She may miss some areas of the room.
Rationale: _______________________________________________________________________________________
_________________________________________________________________________________________________

LESSON WRAP-UP (5 minutes)

In your work tracker, put a mark or encircle which session have you finished today. This is to provide a visual and help
students track how much work they have accomplished and how much work there is left to do.

Activity: The Muddiest Point

Each student to bring out a sheet of paper and will be given a minute or two to answer. After the activity, instructor will
randomly select 3 students to share their answers to the class.

In today’s session, what was least clear to you?

1. __________________________________________________

_________________________________________________________

__________________________________________________________

Reading Assignment: Chapter 28 – Immobility

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