Principles for cleaning and disinfecting non-critical environments in hospitals

Furthermore, surface disinfection is a key component of standard precautions; the first line of infection prevention and control in the healthcare environment. 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 infection outbreak management. KLINTENSIV® – Ready-to-Use Surface Disinfectant is a product specifically designed to prevent the spread of micro-organisms from work areas.

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 strategies, 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.

Non-critical and critical space in hospitals

Medical devices are classified into two main categories according to their degree of invasiveness and the risk they pose to patients. These categories are:

1. Critical medical devices: these are medical devices that come into direct contact with the patient’s tissues or vascular system, thereby placing patients at high risk of pathogen contamination. Examples of critical devices include surgical needles, urinary catheters, endoscopes, dental instruments used inside the oral cavity and other equipment that penetrate body tissues or blood circulation. These devices require rigorous disinfection and sterilization between uses to prevent transmission of infection.

2. Non-critical medical devices: These are medical devices that only come into contact with the patient’s intact skin or the environment and present a lower risk of transmission of infection. Examples of non-critical devices include stethoscopes, blood pressure monitors, thermometers, examination tables, temperature measuring instruments and other similar equipment. Although the risk of transmission of infection is lower in this case, it is still important that these devices are properly cleaned and disinfected between uses to ensure a safe environment for patients and healthcare workers.

Key principles for cleaning surfaces in clinics and hospitals

Use of detergent

A detergent is an active chemical substance, also known as a surfactant, that helps remove dirt and organic matter from surfaces. KLINOZYME – Concentrated Trienzymatic Detergent is an example of an effective detergent, specially designed to ensure proper cleaning and decontamination of surfaces and medical equipment.

In general, most hard surfaces can be effectively cleaned with warm water and a neutral detergent according to the manufacturer’s instructions. It is important to follow detergent directions for best results. After cleaning, it is essential to allow the surfaces to dry completely, as excessive moisture can encourage the growth of micro-organisms and lead to further contamination.

Physical cleaning with a detergent and water is recommended for routine cleaning. The use of KLINOZYME detergent can be beneficial for the removal of hard-to-clean soiling and the removal of organic matter from surfaces and medical equipment, ensuring a clean and hygienic environment in healthcare facilities.

Routine floor cleaning using detergent and water is recommended. Floors, even after they have been cleaned, can quickly become recontaminated with dust particles, debris from footwear or the wheels of medical equipment. These micro-organisms may remain active on the floor surface, but the risk of transmitting infections to patients is considered minimal in this context.

The use of a special floor cleaning solution can help to remove dirt and micro-organisms from the floor surface, ensuring a more hygienic environment in healthcare facilities. The use of a floor cleaning solution can provide an extra level of cleaning and disinfection, thus helping to maintain a safe and clean environment for patients and healthcare staff.

Use of disinfectants

A disinfectant is a chemical substance that has the ability to rapidly destroy or inactivate most pathogens such as bacteria, viruses and fungi. It is important to understand that disinfectants are not intended for general surface cleaning as they do not remove dirt or organic matter. However, there are disinfectants that are combined with a detergent to form combined cleaning agents, also called detergent-disinfectants.

KLINTENSIV® – Ready-to-use surface disinfectant is an example of a ready-to-use surface disinfectant, designed to provide effective disinfection of various surfaces in healthcare facilities. This disinfectant is ready for immediate use and can be applied directly to surfaces without the need for dilution or other preliminary procedures. Regular use of a disinfectant such as KLINTENSIV® can help to reduce the risk of infection transmission and maintain a hygienic environment in healthcare facilities.

Disinfection should always be carried out after and in addition to detergent cleaning.

The use of a disinfectant is required:

• for cleaning surfaces (including floors) suspected or known to be contaminated with a multi-drug resistant organism; a potential outbreak organism; 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 after care of a patient with multi-drug resistant organisms or other infectious diseases.

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.

Only professional medical disinfectants should be used as they are the only products that guarantee the elimination of pathogens.

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 a disinfectant, ensure that the contact time is correct (i.e., the time required for the disinfectant to be in contact with the surface to inactivate microorganisms).
• Ensure regular replacement of solutions, especially when cleaning heavily contaminated areas; when solutions appear visibly soiled; and, immediately after cleaning up spills of blood and body fluids.

Routine practices

Routine practices are implemented by all healthcare providers to prevent the spread of infection. They include (but are not limited to):

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• point-of-care risk assessment
• personal protective equipment
• handling patient care items and equipment
• handling waste and sharps
• cleaning the environment

Hand hygiene is the most important factor in preventing the transmission of micro-organisms. Carry out hand hygiene according to the techniques recommended by the relevant institutions.

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):

• Dedicated to a specific member of staff;
• o clean in accordance with the manufacturer’s instructions;
• o ensure gloves are dry inside and out before reuse;
• o 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 the disinfectant.

Disinfection is the process by which pathogenic micro-organisms are neutralized or destroyed, preventing them from causing further disease. This process can be accomplished by applying a ready-to-use disinfectant wipe or by using a cloth soaked in a disinfectant solution prepared according to the manufacturer’s instructions. It is essential that the surface remains wet for the full contact time recommended by the manufacturer to ensure effective disinfection.

An example of a high performance concentrated disinfectant is SPORYCIDE® – High Level Disinfectant Concentrate. It is designed to provide a powerful action against a broad spectrum of pathogenic micro-organisms, helping to improve hygiene in sanitary environments. The proper use of a disinfectant like SPORYCIDE® can be crucial in preventing the transmission of infections and maintaining a safe environment for patients and healthcare staff.

When a disinfectant is formulated to provide both cleaning and disinfecting properties, it can be used at both stages of the sanitizing process, according to the instructions on the package. This type of product, known as an enzymatic disinfectant detergent, can be effective in removing dirt and organic matter from surfaces, while at the same time destroying or inactivating pathogens.

Enzymatic disinfectant detergents are special formulations containing active enzymes that help to effectively break down and remove proteins, fats and other organic matter such as blood or secretions. These products are commonly used in medical environments and in other areas where hygiene is crucial, such as in the food industry or the service sector.

The use of an enzymatic disinfectant detergent can be an effective option for cleaning and disinfecting surfaces, ensuring a safe and hygienic environment in the different areas of application. It is important to follow the manufacturer’s instructions for use to achieve the best sanitizing results.

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;
• collect and handle waste bags on top;
• Check sharps containers and replace when 3⁄4 full or when they reach the fill line;
• do not overfill.

Prepare cleaning and sanitizing solutions:

• Dispense cleaning and disinfecting products in clean, dry, properly sized containers that are clearly labeled and dated. Discard solution after expiration date.
• Check solution concentration according to facility policy and manufacturer’s instructions, using the manufacturer’s recommended test strips, at least daily 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. Bathrooms should be cleaned last; o from low to high touch surfaces.

Cleaning and disinfection products and equipment

• Use only professional cleaning and disinfection products and equipment intended for use in the in-hospital environment. Do not use unapproved 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, 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 pieces of non-critical equipment disinfected between patients at the point of care, e.g. stethoscope.