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Principles for cleaning and disinfecting non-critical environments in hospitals using instrumental disinfectants
Surface cleaning is an important strategy for reducing the transmission of pathogenic organisms and preventing healthcare-associated infections in healthcare facilities. The role of sanitation is to reduce the number of infectious agents that may be present on surfaces and to minimize the risk of transfer of microorganisms from one person/object to another, thereby reducing the risk of infection.
Furthermore, disinfection of surfaces is a key component of standard precautions; the first line of infection prevention and control in the healthcare environment, and the use of disinfected instrumentation is essential. These work practices are recommended for the treatment and care of all patients. The importance of cleaning and decontamination of the environment is increased when these processes are used as part of transmission-based precautions and outbreak management.
In recent years, there has been a consensus on the need to improve the procedures for cleaning, sanitizing, and disinfecting surfaces in hospitals and clinics. The use of surface disinfectants and instrument disinfectants is mandatory, but care must also be taken to choose suitable and effective products and to use them correctly.
Some experts favor the physical elimination of microorganisms using only a detergent solution and a degreaser. Other experts believe that manual surface disinfection using currently available disinfectants is adequate and that newer approaches to disinfection are not necessary. (Source)
Furthermore, cleaning procedures should be considered an essential part of a comprehensive infection prevention program in hospitals, with protocols put in place to support good performance and should include strategies for optimizing product use product optimization, technique, audit and feedback, education of cleaning staff, and communication. The National Healthcare Safety and Quality Standards require healthcare facilities to have processes in place to maintain a clean and hygienic environment.
Key principles for the surface cleaning process in health facilities
Use of detergent
A detergent is a surface-active agent that facilitates the removal of dirt and organic matter, including from floors.
Most hard surfaces can be adequately cleaned with warm water and a neutral detergent according to the manufacturer’s instructions. The surfaces must be dried before applying another product such as surface disinfectants.
Physical cleaning with a detergent and water is recommended for routine cleaning.
Routine cleaning of floors with detergent and water is recommended. Areas of floors freshly cleaned may be quickly recontaminated by shoes, equipment wheels, dust, etc. and microorganisms on the floors, but pose minimal risk to patients. A suitable solution, e.g. detergent and degreaser and not a universal product.
Use of disinfectants
A disinfectant is a chemical agent that rapidly kills or inactivates most infectious agents. Surface disinfectants should not be used as general cleaning agents, unless combined with a detergent as a combined cleaning agent (detergent-disinfectant), but also with instrument disinfectants.
Disinfection must always be carried out after and in addition to cleaning with detergent and degreaser.
The use of a disinfectant is required:
- for cleaning surfaces (including floors) suspected or known to be contaminated with a multi-drug resistant organism; an organism with outbreak potential; and/or, other potentially infectious materials, including blood and other body fluids.
- in high or extreme risk environments (according to local risk assessment)
- for discharge cleaning following care of a patient with multi-drug resistant organisms or other infectious diseases.
- for the sanitization of utensils, in which case the use of instrument disinfectants.
The routine use of a disinfectant in other areas of a health facility or for cleaning all discharges should be determined locally by the Infection Prevention and Control Team, after conducting the following actions a risk assessment that takes into account the local epidemiology of the disease.
Choice of a disinfectant
When evaluating and selecting a disinfectant in a health facility, factors such as concentration, wet contact time, compatibility, safety, ease of use and value for money should be considered.
Klintensiv Tip: We recommend the use of professional medical disinfectants only, as these products are the only ones that guarantee the elimination of pathogens.
New disinfectants that are currently available or in development include hydrogen peroxide-enhanced liquid disinfectants, peracetic acid and hydrogen peroxide combination, electrolyzed water, cold atmospheric pressure plasma and polymer guanidine. Several hydrogen peroxide-enhanced disinfectants have proven to be effective one-step cleaning/disinfecting agents that significantly reduce bacteria levels on surfaces and floors. (Source)
Considerations on the use of disinfectants
Care must be taken to ensure that the correct chemical is used properly and according to the manufacturer’s specifications.
When using instrument disinfectants, the contact time must be correct (i.e. the time required for the disinfectant to be in contact with the surface to inactivate microorganisms).
Regular replacement of solutions is also required, especially when heavily contaminated areas are being sanitized; when solutions appear visibly soiled; and, immediately after cleaning up blood and body fluid spills.
Routine practices
Routine practices are implemented by all healthcare providers to prevent the spread of infection. They include (but are not limited to): (Source)
- hand hygiene
- point-of-care risk assessment
- personal protective equipment
- handling patient care items and equipment
- waste and sharps handling and use of instrument disinfectants
- cleaning the environment
- use of a degreaser for visibly soiled areas.
Klintensiv Tip: Hand hygiene is the most important factor in preventing the transmission of microorganisms. This should be done by using solutions certified and approved by the Ministry of Health through the National Commission for Biocidal Products.
Perform point-of-care risk assessment before cleaning the patient room or space to assess the likelihood of exposure to blood and body fluids. Choose appropriate protective equipment to minimize the risk of exposure.
Wear gloves before coming in contact with blood and body fluids, excretions or secretions and when handling soiled or potentially contaminated objects.
Wear disposable gloves for routine cleaning activities.
If reusable gloves are required (intended for use when a glove with greater physical protection is required, e.g. recommended in the manufacturer’s instructions for use, cleaning rough surfaces):
- clean in accordance with the manufacturer’s instructions;
- ensure gloves are dry inside and out before reuse;
- inspect the material until it has reached its intended purpose and discard if it shows signs of damage, peeling, discoloration, tears, holes or punctures.
Wear extra equipment such as gowns, eye protection and masks if necessary to protect skin and clothing from splashes or sprays, for example when cleaning up large spills.
Methods for cleaning and disinfection
Cleaning is the physical removal of dirt and debris by the mechanical action of wiping with a clean, damp mop or cloth. Surfaces must be cleaned of visible dirt before they can be disinfected, as dust, dirt and organic matter interfere with the effectiveness of disinfectants. For floors use a product with enhanced soil-removing capabilities.
Disinfection is the inactivation of disease-causing microorganisms by moistening a surface with a ready-to-use disinfectant wipe or disinfectant-saturated swab. To achieve effective disinfection, the surface must remain wet for the contact time recommended by the manufacturer.
If a disinfectant claims to have both cleaning and disinfecting properties, the product may be used for both steps, following the manufacturer’s instructions.
Before cleaning:
- gather the necessary cleaning materials;
- remove unnecessary objects from surfaces to be cleaned;
- clean reusable equipment before removing it from the patient space, possibly using a degreaser;
- collect and handle waste bags on top;
- check sharps containers and replace them when full.
Prepare cleaning and disinfecting solutions:
Dispense instrument disinfectant, hand sanitizer, and hand sanitizing solutions in clean, dry, appropriately sized containers that are clearly labeled and dated. Discard the solution after the expiration date.
Check the solution concentration according to facility policy and manufacturer’s instructions, using the manufacturer’s recommended test strips, at least once a day or more frequently, depending on site requirements.
During the cleaning and disinfection process:
- follow the manufacturer’s contact time instructions for disinfection;
- use a clean washcloth to dip into the cleaning or disinfecting solution. Do not soak a used cloth in the cleaning or disinfecting solution (double dip);
- start cleaning from clean to dirty areas. Baths should be cleaned last; o from low to high-touch surfaces.
Products and equipment for cleaning and disinfecting
Use only professional cleaning and disinfection products and equipment intended for use in the in-hospital environment. Do not use non-approved products such as household cleaning products.
Select the appropriate product for the intended task, e.g. cleaning or disinfecting.
Follow the manufacturer’s instructions for use and safety data sheets, e.g. wear gloves when handling, if recommended, for both products and equipment.
Barriers, e.g. covers, and wraps, can be used to protect surfaces from soiling, but do not replace the cleaning process.
Do not mix different types of cleaning/disinfecting products (unless specified by the manufacturer) as the chemicals may react with each other, e.g. enhanced hydrogen peroxide products and quaternary ammonia products.
Use ready-to-use disinfectant wipes for point-of-care cleaning and disinfection of patient equipment such as:
- items in the environment of care that do not tolerate soaking (multiple wipes are required for disinfecting large pieces of non-critical equipment).
- small items of non-critical equipment disinfected between patients at the point of care, e.g. stethoscope.
Conclusion
Hygiene is a first step towards a safe environment in hospitals and clinics. Cleaning procedures are the first step in the process of removing potentially harmful pathogens. In addition to cleaning, disinfection of surfaces and instruments is required, especially in critical areas where infectious diseases are treated, using instrument disinfectants. The use of professional solutions is always required, due to their properties to remove a broad spectrum of microorganisms.