Unit Four: Clean

environmental
surfaces
Learning objectives
▪ General principles of environmental cleansing
▪ Wearing personal protective equipment
▪ Remove dust, dirt and physical debris from work surfaces ▪ Clean work
surfaces
▪ Dry work surfaces
▪ Replace work surfaces
▪ Maintaining and storing equipment
Definitions of Key Terms
▪ Biofilm: is an accumulated, thin layer of bacteria and extracellular
material that tightly adheres to surfaces (e.g., skin drains, urinary
catheters) and cannot be easily removed.
▪ Cleaning: is the removal of visible dirt from objects and surfaces,
normally accomplished manually or mechanically, using water with
detergents or enzymatic cleaners.
▪ Cleaning Solution: is any combination of soap or detergent and water,
with or without a chemical disinfectant used to wash or wipe down
surfaces such as floors, chairs, bench tops and walls.
▪ Contact time: is the length of time a cleaning product must remain
wet on the surface being cleaned for the disinfectant to kill the targeted
microorganisms.
▪ Detergent (soap): is a cleaning product that lowers surface tension of
water, thereby helping to remove dirt and debris.
▪ Disinfectant Cleaning Solution: is a product that is a combination of
detergent (soap) and a chemical disinfectant. It is true, that not all
detergents and disinfectants are compatible.
▪ Disinfectants: are chemicals that destroy or inactivate microorganisms
▪ Environmental cleaning: it is the general cleaning of surfaces and
equipment to reduce the number of microorganisms present and
providing a clean and pleasant atmosphere.
▪ Environmental Controls: activities of keeping standards specifying
procedures to be followed for the routine care, cleaning and disinfection
of surfaces, beds, bedrails and bedside equipment
▪ Frequently touched surfaces: are surfaces in patient care areas in the
health care facility with frequent hand contact.
▪ Non-critical items: for the purposes of cleaning and disinfection, are
items that come into contact with intact skin but not mucous membranes
(e.g., blood pressure cuffs, stethoscopes, and crutches
▪ Sanitizer: a chemical that reduces the number of bacterial
contaminants on inanimate objects to safe levels based on public
health requirements
▪ Sterilants: these are Chemicals used to destroy all forms of
microorganisms including endospores. 4
General Principles for Cleaning
▪ Scrubbing (frictional cleaning) is the best way to physically remove
dirt, debris and microorganisms.
▪ Cleaning is required prior to any disinfection process because dirt,
debris and other materials can decrease the effectiveness of many
chemical disinfectants.
▪ Cleaning products should be selected on the basis of their use,
efficacy, safety and cost.
▪ Cleaning should always progress from the least soiled areas to the
most soiled areas and from high to low areas so that the dirtiest areas
and debris falling on the floor will be cleaned up last.
▪ Dry sweeping, mopping and dusting should be avoided to prevent
dust, debris and microorganisms from getting into the air and landing
on clean surfaces.
▪ Instructions for mixing (dilution) should strictly be followed when
using disinfectants.
Wearing Personal protective
equipment (PPE)
PPE for environmental cleansing
When cleaning environmental surface it is highly recommended to
wear personal protective equipment. Under the current Covid-19 risk,
the essential cleaning PPE will be gloves and aprons, ideally simple
disposable ones, or with a careful routine of cleaning if not. Other
personal protective equipment like mask, shoes, eye ware also
required.
A. Aprons They can range from basic ones below waist, to more
commercial ones covering the whole person and ‘hanging’ around the
neck. They can also be a variety of colors and designs, with any relevant
logos and contact details for the cleaning firm using them
B. Glove These not only help protect hands from substances and harm,
but can likewise help prevent germs and bacteria from people’s hands
being directly transferred onto items being cleaned and used.
Therefore, cleaning without gloves should be very infrequent
PPE for Housekeeping
The housekeeping staff in health facilities deals with dirt, soils and other
materials that expose them to risks of infections and other health hazards. To
avoid this hazardous exposure, they have to be equipped with the relevant
personal protective equipment. Some of personal protective equipment for
housekeeping purposes is:
• Gloves preferably the utility or Heavy-duty gloves
• Protective shoes
• Plastic or rubber apron
• Masks
• Protective eye wears
The housekeeping staffs should use the above-mentioned PPEs for: -
Handling disinfectant cleaning solutions, cleaning patient care areas,
cleaning heavily contaminated areas, handling soiled linens, handling
soiled items and instruments, handling or disposing of wastes and
When spills or splashes are expected
Remove dust, dirt and physical
debris from work surfaces
Dust, soil and microbial contaminants on environmental surfaces are potential source
of HAIs. Maintaining a clean workplace increases productivity and safety. It also
decreases the likelihood of adverse, work-related health issues. Necessary levels of
cleanliness vary by industry. The needs of a food processing facility, for example, are
typically going to be more extensive than those of a machine shop. Determining the
optimal level of cleanliness to meet health, safety and production needs allows
facilities to create cleaning, sanitizing and disinfecting regimens that are realistic and
not overly burdensome. Unlike many situations where going “above and beyond” is a
good thing, over-cleaning may be wasting time and resources.
Cleaning a surface removes visible dirt, dust and debris. Sweeping floors, washing
windows and wiping spills from countertops are examples of cleaning. When facilities
establish routine cleaning schedules and adhere to them, they reduce the likelihood
of dirt, spills and clutter creating unsafe working conditions.
Cleaning work surfaces
Prepare a Disinfectant Cleaning Solution The disinfectant cleaning solutions contain
both disinfectants for decontamination and detergents (soap) for cleaning.
Ways of preparing disinfectant cleaning solutions.
• STEP 1: Prepare a 0.5% Chlorine solution from liquid concentrates or from
Chlorine powder compounds. Alternative disinfectants that can be used include 1 to
2% Phenols or 5% Carbolic acid.
• STEP 2: Add enough detergent to the 0.5% Chlorine solution or another
disinfectant to make a mild and soapy cleaning solution.
When we use Chlorine solution, we should be very cautious. Although chlorine-
containing solutions (sodium hypochlorite) are excellent and inexpensive
disinfectants, they should not be mixed with cleaning solutions containing an acid
(e.g. phosphoric acid) like Ammonia or Ammonium chloride
Cleaning Methods Cleaning should start with the least soiled area and
extend to the most soiled area and from high to low surfaces. Before
started cleaning it is necessary to prepare cleaning solution and the full
steps will be discussed on the operation shit of this learning outcome
Common methods of cleaning are briefly described below:
Wet Mopping Method (Preferable for Floor Cleaning)
▪ Single-Bucket (Basin) Technique: one bucket of cleaning solution is used here.
The solution, however, needs to be changed when dirty. (The killing power of
the cleaning product decreases with the increased load of soil and organic
material present).
▪ Double-Bucket Technique: two different buckets are used here-one containing
a cleaning solution and the other containing water for rinsing. The mop is
always rinsed and wrung out before it is dipped into the cleaning solution. The
double-bucket technique extends the life of the cleaning solution (fewer
changes are required) saving both labor and material costs.
▪ Triple-Bucket Technique: the third bucket is used for wringing out the mop
before rinsing which extends the life of the rinse water.
Flooding Followed by Wet Vacuuming Method
▪ It is preferable for surgical suits.
▪ It eliminates mopping and minimizes the spread of micro-organisms.
▪ It increases the contact time of the disinfectant and the area to be cleaned.
▪ Preferably, it should be done at night when the traffic flow of the facility is low.
Dusting:
▪ Should be used for cleaning walls, ceilings, doors, windows, furniture and other
environmental surfaces. Clean clothes or mops are made wet with cleaning solution
contained in a basin or bucket. The double-bucket system minimizes the contamination of
the cleaning solution.
▪ Dry dusting should be avoided, and dust cloths should not be shaken either for fear of
spreading of micro-organisms.
Dry Vacuuming: This is recommended only for cleaning carpets.
Drying work surfaces After cleaning is done, the final stage of cleaning
is to dry the surface, and it’s recommended that you air dry where
possible. You can use drying cloths if needed, but they should be single
use if so, especially in a commercial setting. You must not air dry any
drying cloths that are damp from use and reuse them, as bacteria could
grow on the cloths and pose a contamination risk. By this point, the
surface will be fully cleaned and most, if not all, microorganisms will
have been destroyed, depending on the substances you used.
Drying Textile
All textiles (e.g., bed sheets, surgical drapes, and gowns) used in the
direct care of a patient must be thoroughly washed and dried before
reuse. Laundering removes pathogens from textiles, making them
hygienically clean1and ready for use. Laundered textiles are not sterile
and are not required to be, including for neonatal intensive care units.
Laundering standards in hospitals should address key, specific
standards, for example, water quality and temperature, amount of
agitation needed, and chemical properties needed to properly clean
surgical attire.
Effective laundering is dependent on the following factors, which, when
used. together, have a greater effect than when used separately:
▪ Duration of cleaning
▪ Mechanical action (i.e., agitation)
▪ Chemicals used in the process ▪ Temperature of water and air in the
machine dryer If one of these factors is decreased (e.g., temperature),
then other factors (e.g., chemicals, mechanical action, or time) must be
increased to result in the same level of cleanliness.
Drying, Inspecting, and Folding Textiles Steps to dry, inspect, and fold hand- and
machine-washed textiles:
I. Completely air or machine-dry cleaned textile before further processing. A cycle
in the dryer has been associated with elimination of pathogenic bacteria. For air-
drying, direct sunlight is preferred. Keep the fabric off the ground, away from dust
and moisture.
II. After textiles are totally dry, check for holes and threadbare (worn) areas. If these
are present, the item must be discarded or repaired before reuse or storage:
III. Air-dried textiles should be ironed. Ironing has been associated with the
elimination of pathogenic bacteria and is essential to prevent parasites in some
regions.
IV. Clean, dry textiles should be folded If sterile textiles are required
Replace surface covers Commercial surface covers are available in a variety
of shapes and sizes and are often cut to fit the instrument or equipment
they protect - air/water syringe handle covers, hose covers, pen sheaths,
etc. They generally are made of clear plastic supplied as wraps, bags, or
tubes, or as plastic-backed paper. Some barriers contain a mild adhesive
on one side to keep them in place on the surface; others might use a
drawstring closure to secure the cover; and some plastics "cling" when
placed in contact with a smooth surface. In selecting environmental
surface barriers, the primary feature is impermeability, and any material
manufactured and advertised as a surface barrier should be supplied with
evidence of the impermeable nature of the product.
Maintaining and storing equipment
Storing Equipment All sterile items should be stored appropriately to
protect them from dust, dirt, moisture, animals and insects. The
storage area should be located next to the place of sterilization or
connected to it in a separately enclosed area with limited access that is
used just to store sterile and clean patient care supplies. In smaller
clinics, this area may be just a room close to the Central Supplies
Department or in the Operating Room.
Instructions for Storing Sterile Items
• Keep the storage area clean, dry, dust-free and lint-free.
• Control temperature and humidity (approximate temperature 24oC)
• Packs and containers for items should be stored 20 to 25cm off the
floor, 45 to 50cm from the ceiling and 15 to 20cm from an outside wall. •
Do not use cardboard boxes for storage because cardboard boxes shed
dust and debris and may harbor insects.
• Date and rotate the supplies (first in/first out). This process serves as a
reminder, but does not guarantee sterility of the packs.
• Distribute sterile and high-level disinfected items from this area.
Shelf Life The shelf life of an item (how long items can be considered
sterile) after sterilization is event- related. An item remains sterile until
something causes the package or container to become contaminated as
time goes on since sterilization is not the determining factor. To make
sure items remain sterile until you need them, prevent events that can
contaminate sterile packs and protect them by placing them in plastic
covers (thick polyethylene bags). An event can be a tear or worn-out
area in the wrapping, the package becoming wet or anything else that
will enable microorganism to enter the package becoming wet or
anything else that will enable microorganism to enter the package or
container.
Before using any sterile item, look at the package to make sure that the
wrapping is intact and the seal is unbroken, clean and dry (as well as
having not water stains). If the quality of wrapping clothes is poor and
plastic bags are not available, limiting the shelf life is a reasonable
option to resort to and secure the sterility of the instruments.
Storing Hygienically Clean Textiles Procedures for proper storing of hygienically clean textiles:
▪ Store clean textiles in clean, closed storage areas.
▪ Store clean textiles in an area free of pests, dust, and lint and at room temperatures of 20–
25.6°C (68–78°F).
▪ Use physical barriers to separate folding and storage rooms from soiled areas.
▪ Ensure that storage shelves are: 2.5 to 5 cm (1 to 2 inches) from the wall
▪ Bottom shelf: 15 to 20 cm (6 to 8 inches) from the floor
▪ Top shelf: 30 to 45 cm (12 to 18 inches) below the ceiling
▪ Keep shelves clean and textiles covered, which can be achieved by: covering clean textiles on
a clean cart
▪ Wrapping bundles of clean textiles in plastic or other suitable material and closing securely
and Restrict access to the laundry storage room to authorized staff.
The Shelf Life of Sterilization Depends on the Following Factors:
▪ Quality of the wrapper or container.
▪ Number of times a package is handled before use.
▪ Number of people who have handled the package.
▪ Whether the package is stored on open or closed shelves.
▪ Condition of storage area (e.g. humidity and cleanliness).
▪ Frequent or improper handling or storage.
▪ Use of plastic dust cover and method of sealing (AORN, 1992).