Cleaning is defined as the physical removal of dirt, body fluids, and

other organic matter.

Cleaning is achieved through the use of a detergent, water, and applied friction.

Disinfection is the destruction of pathogens on a surface.

This is most commonly done through the use of the environmental protection agency,

EPA, registered chemical.

Disinfection can also be achieved through the application of heat,

ultraviolet light, or vaporized hydrogen peroxide.

A surface cannot be disinfected unless it has been cleaned

because organic matter can interfere with some disinfectants.

Disinfection reduces the number of pathogens on a surface

to a level where they are unlikely to cause harm.

However, the use of a disinfectant does not produce a sterile surface.

Though defined separately here, cleaning and disinfection is a one-step process,

and occurs simultaneously when applying a disinfectant to a surface.

As such, it is not necessary to pre-clean a surface prior to disinfection

unless the surface is heavily contaminated with blood or body fluids.

As we proceed through this module we will refer to this one-step process as

Cleaning Disinfection.

The decision to use a particular disinfectant

requires careful consideration of multiple variables.

First, the product must be an EPA registered disinfectant.

In the United States the EPA registers all surface disinfecting products and

indicates their level of effectiveness against certain pathogens.

The product selected should be EPA-registered for use in healthcare.

Next, consider the different pathogens a disinfectant kills.

It is important to check the product label to ensure that it has a kill claim

against the pathogens of concern.

Other variables to considered are the safety and toxicity to residents and staff

and any potential damage to equipment and surfaces due to materials incompatibility.

There are many methods available to apply disinfectants including cotton cloths,

disposable wipes and microfiber.

The method of application is a matter of choice dependent primarily on

the availability, convenience and cost of laundering reusable application products.

If using a reusable method, make sure that the material is durable and

can survive repeated use and cleaning.

It is also important to ensure that the cloth you are using is large enough and

wet enough to clean the intended surface.

Cloths and

wipes are available that maintain wetness to cover a certain surface area.

A wet cloth will effectively kill and remove pathogens easily, but a dried

out wipe will spread pathogens over the surface and not effectively remove them.

Once the wiper cloth is dried out or

contaminated on both sides, it must be discarded.

It is also important not to double-dip.

That is, returning a soiled cloth or mop back into the disinfectant.

This practice contaminates the disinfectant over time and

spreads bacteria rather than removing it.

It is important to change cloths, mops, and

disinfecting solutions frequently to ensure adequate cleaning.

Items must be exposed to the disinfectant for the appropriate minimum contact time,

which can range from 1 to 10 minutes, depending on the disinfectant.

This information is also specified on the product label.

It is best to evaluate multiple disinfectants and

to select the disinfectant with the lowest contact time possible

to avoid the need for multiple application should

the product dry on the surface before the required contact time has elapsed.

All staff should be trained to use the longest contact time on the label

to simplify training, and improve compliance.

As a final note, EPA requires that manufacturers state on the label,

that it is a violation of federal law to

use this product in a manner that is inconsistent with its labeling.

Regulatory agencies like CMS have interpreted this statement to mean

the longest contact time on the label and are audited using this interpretation.

Because occupational diseases among environmental services staff have been

associated with the use of several disinfectants,

precaution should be taken to minimize exposure.

Precautions include wearing the appropriate personal protective equipment

when mixing and using disinfectant chemicals.

Safe storage and labeling of disinfectants, and

proper ventilation of areas where chemicals are mixed, stored, and used.

Different disinfectant products should not be mixed together.

It is important to follow safety precautions found on the safety

data sheet, SDS, provided by the manufacturer.

The SDS should be on file and readily available to staff.

Now, back to Sunnyside with Charlie and Sarah.

>> Charlie, I already feel better about my job here at Sunnyside Nursing Home.

I really can make a difference.

>> Let's not get too hasty, Sarah.

Cleaning isn't a single-celled organism.

It's got many parts to it, and

all those parts are to prevent the spread of infection to residents everywhere.

>> Tell me more.

>> Well, environmental surfaces, like the bed, and

this table, even the windowsill, are contaminated with germs,

such as bacteria and fungi, and can be a reservoir for infections for residents.

In fact, I just read this cool study, that showed that residents colonized or

infected with antibody resisting bacteria like MRSA or

VRE contaminated their environment.

And when that room is not clean well, after they have been discharged

the next resident is at risk for becoming colonized or infected with the same germ.

>> Wow I had no idea, why is that?

>> Well it turns out that while we thought we were doing a good job cleaning

rooms between residents, we really weren't.

We often miss hand contact surfaces and

items in the room that were contaminated, which led to an increased risk

that the next resident might get the germ that was infecting the other resident.

That reminds me, we need to talk about the second P, practice.

Have you ever thought about which surfaces to clean in a room?

>> No, not really, I just try and

wipe what looks dirty and hope I haven't missed a spot.

>> Sorry my friend, it's not enough to only clean what looks dirty,

we should try to be as thorough as possible when we clean residence rooms and

wipe every surface.

Let me show you a little something I've patented as my signature move around here.

I call it the Triple Threat.

>> Triple Threat.

>> Triple Threat?

>> The Triple Threat.

One, two, Three, clean.

Three means clean.

Three times the cleaning power in each action.

It's not just product that's going to get this place clean, it's good practice and

thoroughness.

>> I'm not sure I understand how this works and what you mean by thoroughness.

>> Here, let me show you.

Charlie?

What is that?

>> Well, what you see here is that I've secretly put dots

scattered across this room to see how we're coming with your cleaning.

Where did you say you've wiped so far?

>> I thought I was done with this room.

>> Well Sarah, every place that you see these dots still showing up, means that

you don't give that area the cleaning job that I know that you're capable of.

>> So you're telling me all of these surfaces need to be wiped over again?

Sara, this is not a race to see who finishes first.

Remember, it is about the thoroughness of cleaning.

We use the dots to simulate surface contamination.

When you wipe over the dot, you remove it,

which indicates you have adequately cleaned the surface.

Here's the best part.

You never know when I'm going to dot a room.

So, you have to do a great time every time!

>> So what should I clean?

>> You should be cleaning from cleanest to dirtiest, saving the bathroom and

floor for the end.

As for as surfaces, you should focus your attention on the touchable surfaces,

especially closest to the resident.

These will be things like the bed rails, the frame,

the call button, the door knobs, things like that.

>> I can see my day just got a lot longer.

>> Don't think of it as longer.

Think of it as more effective.

We have a great product.

But without great practice and attention to detail,

we cannot do our part to reduce the chance of residence getting infections.

4.2 How to clean the environment effectively

Infection Prevention in Nursing Homes

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