Effective Surface and Environment Cleaning

It is crucial to ensure surfaces and environments in healthcare settings are cleaned thoroughly and properly in order to prevent infection transmission, keeping your patients, staff and visitors safe and healthy.

Healthcare-associated infections (HAIs) can be transmitted in any healthcare setting with approximately 165 000 cases occurring per year, potentially leading to poor patient outcomes, adding extra costs and increasing patient length of stay in hospital (NHMRC 2019).

n addition to patients, HAIs also pose a risk to staff or any other people who enter a healthcare facility (NHMRC 2019).

Therefore, the effective implementation of infection prevention and control is crucial to ensure that high quality healthcare is provided to patients, and a safe working environment is maintained for staff (NHMRC 2019).

Successful infection prevention and control relies on a sound understanding of the modes of transmission and when preventative measures should be taken. This is the responsibility of not only healthcare staff, but also visitors, patients, carers and administrators (NHMRC 2019).

Infectious agents or pathogens are disease-causing microorganisms that comprise bacteria, viruses, fungi and parasites (NHMRC 2019).

Many of these infectious agents exist in healthcare settings, in most cases originating from human sources (patients and staff). They are most commonly transmitted to others through contact (direct or indirect), droplet or airborne routes (NHMRC 2019).

The spread of these infectious agents between susceptible ‘hosts’ is a process known as the chain of infection, and preventing transmission relies on inhibiting the chain at any of its six links:

(NHMRC 2019)

For more information about infectious agents and the chain of infection, refer to Infectious Diseases: How Do You Break the Chain?.

Successful prevention and control of infections involves the implementation of the following two-tiered approach:

• Basic measures of infection prevention and control that should be used for all patients regardless of their infectious status.
• Should be in practice all of the time in order to achieve a basic level of infection control.
• They include:
  • Appropriate hand hygiene as per WHO’s Five Moments for Hand Hygiene;
  • Use of PPE according to the task being undertaken and level of risk;
  • Appropriate handling of sharps, waste and linen;
  • Respiratory hygiene and cough etiquette;
  • Aseptic technique;
  • Environmental cleaning and reprocessing of equipment and instruments; and
  • Cleaning of shared patient equipment.

(SA Health 2017; ACSQHC 2019; NHMRC 2019)

• Additional measures designed to interrupt a specific infectious agent and its mode of transmission.
• Used to control infection risk with patients who are suspected or confirmed to be in contact with infectious agents transmitted by contact, airborne or droplet routes.
• Used during outbreaks.
• Used if standard precautions alone are insufficient.
• They may include:
  • Isolation in a room (with or without negative pressure ventilation); and
  • Enhanced cleaning of the room with detergent and disinfectant (both while the patient is present and when the room is vacant); and
  • Additional PPE.

Environmental surface cleaning relates to the cleaning of surfaces and objects in order to reduce contamination from infectious agents that may be present, and as a result prevent cross-infection (SA Health 2019).

The act of cleaning aims to remove foreign materials including dust, soil, blood, secretions, excretions and micro-organisms from surfaces and objects. This is achieved through a combination of water, detergent and friction (SA Health 2017).

According to the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019), it is good practice to clean as follows:

• High-touch surfaces (e.g. door handles, bed rails, tabletops, light switches) should be cleaned daily with a detergent solution, when visibly soiled and after every known contamination.
• Low-touch surfaces (e.g. floors, ceilings, walls, blinds) should be cleaned when visibly soiled and right after spillage.

(NHMRC 2019; DoH 2020)

Additionally, wet areas such as toilets, sinks, baths, showers and basins should be cleaned at least daily, and more frequently if needed (VIC Health n.d.).

There are two types of chemicals used for cleaning in healthcare settings:

(SA Health 2017; DoH 2020)

Cleaning solutions should be prepared right before use (VIC Health n.d.).

Remember to follow workplace health and safety instructions and the manufacturer’s recommendations before using a disinfectant (VIC Health n.d.).

Generally, the following principles apply to equipment used for cleaning:

• Equipment that disperses dust (e.g. broom) or generates aerosols (e.g. spray bottle) should be avoided as it may cause irritation.
• Single-use cleaning items are preferable.
• Reusable cleaning items (solutions, water, buckets, cloths and mop heads) should be changed after each use, and changed immediately if used to clean a body substance spill.
• Buckets should be emptied, washed with detergent and warm water, rinsed with hot water and dried upside-down between uses.
• Mops should be laundered or washed with detergent and warm water, rinsed with hot water and dried between uses.

(SA Health 2017; VIC Health n.d.)