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وزاره الصحه Ministry of Health الاداره العامه لمكافحه عدوي المنشات الصحيه General Directorate of Infection Prevention and Control (GDIPC) Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines All Healthcare Providers Have a Role in Maintaining a Clean & Safe Environment August 2022 Version 1.1 www.moh.gov.sa | 937 | SaudiMOH | MOHPortal | SaudiMOH | Saudi_Moh السلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامه السلامه السلامه السلامه السلامه السلامه السلامه السلامه السلامه ال سلامه السلامه السلامه السلامه السلامه السلامه السلامه السلامه السلامه In the name of ALLAH, Most Gracious, Most Merciful ii|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines- August 2022 - Version 1.1 السلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامت السلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامات ال سلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامات السلامات Contributors: Dr. Sameh Tawfeeq samehtawfeeq@moh.gov.sa Ms. Hind Alenazi Hoalenazi@moh.gov.sa Mr. Adel Alenazi adsualanazi@moh.gov.sa Ms. Wafa Alshammari Wahaalshammari@moh.gov.sa Mrs. Ahlam Alamri ahlama@moh.gov.sa Mr. Rayed Asiri raalasiri@moh.gov.sa Mr. Riyadh Alshehri Rashehri@moh.gov.sa Reviewed by: Mrs. Ahlam Alamri ahlama@moh.gov.sa Approved by: Dr. Khalid H. AlAnazi Kal-enazi@moh.gov.sa iii| Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines- August 2022 - Version 1.1 [Non-Text] احمل الجز Ministry of Health Content DEFINITIONS....5 MICROORGANISMS:....5 CONTAMINATED: 5 INANIMATE SURFACE: 5 CLEANING: 5 ROUTINE CLEANING: 5 ENVIRONMENTAL CLEANING: 5 CLEANING CART (ALSO KNOWN AS CLEANING TROLLEY): 5 CLEANING PRODUCTS (ALSO KNOWN AS CLEANING AGENTS): 5 CLEANING SESSION: 5 CLEANING SOLUTION: 5 CONTACT TIME: 6 SAFETY DATA SHEET (SDS): 6 MATERIAL COMPATIBILITY: 6 PATIENT CARE AREAS: 6 PATIENT ZONE: 6 GENERAL PATIENT AREAS: 6 SPECIALIZED PATIENT AREAS: 6 HEMODIALYSIS STATION: 6 SURGICAL FIELD: 6 HIGH-TOUCH SURFACES: 7 LOW-TOUCH SURFACES: 7 HEAVY-CONTAMINATION AREA: 7 MODERATE-CONTAMINATION AREA: 7 LIGHT-CONTAMINATION AREA: 7 TERMINAL (DISCHARGE) CLEANING: 7 ENVIRONMENTAL CLEANING SERVICES AREA: 7 ANTIMICROBIAL AGENT: 7 ANTISEPTIC: 7 BACTERICIDE: 7 DETERGENT: 8 DISINFECTION: 8 DISINFECTANTS: 8 LOW-LEVEL DISINFECTION: 8 MID-LEVEL DISINFECTION (ALSO INTERMEDIATE-LEVEL DISINFECTION): 8 HIGH-LEVEL DISINFECTION: 8 1|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 al aljig Ministry of Health DISINFECTANT FOGGING: 8 DISINFECTANT SOLUTION: 8 THREE-BUCKET SYSTEM (MOPPING): 8 TWO-BUCKET SYSTEM (MOPPING): 8 REUSABLE PATIENT CARE EQUIPMENT: 9 MICROFIBER CLOTHS: 9 HAND HYGIENE: 9 PERSONAL PROTECTIVE EQUIPMENT (PPE): 9 STANDARD PRECAUTIONS: 9 TRANSMISSION-BASED PRECAUTIONS: 9 - Contact: 9 - Droplet: 9 - Airborne: 9 BIOHAZARD SPILL KITS 9 INTRODUCTION 10 THE INTENDED AUDIENCE OF THE DOCUMENT: 10 PURPOSE OF THE DOCUMENT: 10 EFFECTIVE ENVIRONMENTAL HEALTH PROGRAM 11 1. ORGANIZATION /ADMINISTRATION COMPONENT: 11 2. STAFFING AND TRAINING OF HOUSEKEEPING STAFF'S COMPONENT....11 3. POLICY AND PROCEDURE COMPONENT....12 4. QUALITY MONITORING AND AUDITING COMPONENT....13 ENVIRONMENTAL CLEANING AND DISINFECTION REQUIRED SUPPLIES, EQUIPMENT'S, HEALTH CARE AND UTILITY ROOM DESIGN 16 A. IN ORDER TO SUPPORT THE BEST ENVIRONMENTAL CLEANING & DISINFECTION PRACTICES, THE FOLLOWING GENERAL REQUIREMENTS ARE ESSENTIAL: 16 Environmental surfaces....16 Cloth furnishing:....16 Bedside privacy curtains:....17 Carpeting: 17 B. SOILED (DIRTY) AND CLEAN UTILITY/SUPPLY ROOMS:....17 Soiled utility rooms characteristics:....18 Clean utility room characteristics:....18 C. CLEANING EQUIPMENT: 18 Surface cleaning supplies: 19 Floor cleaning supplies:....19 2 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 al aljig Ministry of Health D. STORAGE OF CLEANING SUPPLIES:....19 E. CLEANING CARTS AND TROLLEYS....20 F. NEW EQUIPMENT/PRODUCT PURCHASES....21 - Method of selecting the environmental cleaning products (e.g., detergents, disinfectants):....21 - The process of selecting cleaning and disinfecting agents....22 ENVIRONMENTAL CLEANING AND DISINFECTING METHODS:...... 27 A. GENERAL OVERVIEW OF THE ENVIRONMENTAL SURFACES: 27 B. CLEANING & DISINFECTION TECHNIQUES:....27 - Daily routine cleaning of the patient room or bed space:......27 - Discharge/Transfer patient room cleaning (Terminal Cleaning):......28 - Floor cleaning:....28 - Cleaning & disinfection of equipment: 29 - Toys/playrooms/activity room cleaning & disinfection: 30 - Transport equipment's & vehicle cleaning & disinfection: 30 - Blood or body fluid spill cleaning and disinfection: 30 C. CLEANING & DISINFECTION STRATEGIES: 30 - Proceed from High to Low (Top to Bottom) 30 - Proceed from Cleaner to Dirtier....31 - Proceed in a Methodical, Systematic Manner .... 31 D. NEW AND EVOLVING TECHNOLOGIES FOR ENVIRONMENTAL CLEANING & DISINFECTION IN HEALTH CARE SETTINGS: 32 - No-touch disinfection systems....32 - Disinfection using hydrogen peroxide vapour or mist: 32 - Disinfection using ultraviolet light: 33 CLEANING PROCEDURES FOR DIFFERENT HOSPITAL AREAS...... 35 A. CLEANING PROCEDURES FOR OPERATING ROOM: 35 B. CLEANING PROCEDURE FOR INTENSIVE CARE UNITS (ICU) (ADULT, PEDIATRIC, NEONATAL): 37 C. CLEANING PROCEDURE FOR SPECIAL ISOLATION UNITS: 38 D. CLEANING PROCEDURE FOR BURN UNITS: 39 E. CLEANING PROCEDURE FOR MEDICATION PREPARATION AREAS: 40 F. CLEANING PROCEDURE FOR STERILE SERVICES AREAS: 40 G. CLEANING PROCEDURE FOR GENERAL PROCEDURE AREAS: 41 H. CLEANING PROCEDURE FOR LABOR AND DELIVERY WARDS/ROOMS: 42 I. CLEANING PROCEDURE FOR HEMODIALYSIS STATIONS/AREAS: 43 3 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] امل alsjg Ministry of Health J. CLEANING PROCEDURE FOR EMERGENCY DEPARTMENT: 44 K. CLEANING PROCEDURE FOR TRANSMISSION-BASED PRECAUTION / ISOLATION WARDS: ...45 L. CLEANING PROCEDURE FOR GENERAL OUTPATIENT AREA: 47 OCCUPATIONAL SAFETY CONSIDERATIONS.... 48 A. PERSONAL PROTECTIVE EQUIPMENT (PPE) IS USED BY CLEANING STAFF FOR PERFORMING CLEANING PROCEDURES ....48 B. IMMUNIZATION 49 C. STAFF EXPOSURE 49 FLOWERS AND PLANTS IN PATIENT-CARE AREAS 50 A. VULNERABLE PATIENT GROUPS 50 B. ENVIRONMENTAL CONTROL MEASURES....50 ENVIRONMENTAL SAMPLING 51 A. AIR SAMPLING....51 B. ENVIRONMENTAL SURFACES SAMPLING....55 C. WATER SAMPLING 56 PEST CONTROL....56 CONCLUSION 56 REFERENCES.... 57 APPENDIX A: GENERAL WARD DAILY CLEANING CHECKLIST FORM......58 DAILY CLEANING CHECKLIST....58 APPENDIX B: OR DAILY CLEANING CHECKLIST FORM....62 (FORM 1 - AT THE BEGINNING AND AFTER THE LAST CASE OF THE DAY)....62 (FORM 2 - BETWEEN CASES) ......64 (FORM 3 - WEEKLY CLEANING AND DISINFECTION OF THE OPERATING ROOM - 1-MONTH PERIOD)....66 APPENDIX C: TERMINAL CLEANING PROCEDURES CHECKLIST (DISCHARGE) FORM 68 TERMINAL CLEANING PROCEDURES CHECKLIST (DISCHARGE)....68 4 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] احمل الجر Ministry of Health Definitions Microorganisms: Animals or plants of microscopic size. As used in healthcare, generally refers to bacteria, fungi, viruses, and bacterial spores Contaminated: State of having actual or potential contact with microorganisms. As used in healthcare, the term generally refers to the presence of microorganisms that could produce disease or infection. Inanimate surface: Nonliving surfaces (e.g., floors, walls, furniture). Cleaning: The physical removal of foreign material (e.g., dust, soil) and organic material (e.g., blood, secretions, excretions, microorganisms). Cleaning physically removes rather than kills microorganisms. It is accomplished with water, detergents, and mechanical action. Routine cleaning: Regular cleaning (and disinfection, when indicated) when the room is occupied to remove organic material, reduce microbial contamination, and provide a visually clean environment. Emphasis is on surfaces within the patient zone. Environmental cleaning: Cleaning and disinfection (when needed, according to risk level) of environmental surfaces (e.g., bed rails, mattresses, call buttons, chairs) and surfaces of noncritical patient care equipment (e.g., IV poles, stethoscopes). Cleaning cart (also known as cleaning trolley): A dedicated cart or trolley that carries environmental cleaning supplies and equipment. Cleaning products (also known as cleaning agents): liquids, powders, sprays, or granules that remove organic material (e.g., dirt, body fluids) from surfaces and suspend grease or oil. Can include liquid soap, enzymatic cleaners, and detergents Cleaning session: A continuous environmental cleaning activity is performed over a defined period in defined patient care areas. A cleaning session could include routine or terminal cleaning. Cleaning solution: A combination of water and cleaning product (e.g., detergent) in a ratio specified by the manufacturer. 5 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليك Ministry of Health Contact time: The time that a disinfectant must be in contact with a surface or device to ensure that appropriate disinfection has occurred. For most disinfectants, the surface should remain wet for the required contact time. Safety data sheet (SDS): A document by the supplier or manufacturer of a chemical product that contains information on the product's potential hazards (health, fire, reactivity, and environmental) and how to work safely with it. It also contains information on the use, storage, handling, and emergency procedures. Material compatibility: Chemical compatibility and other factors affect corrosion, distortion, or other damage to materials. Patient care areas: Any area where patient care is directly (e.g., examination room) and indirectly (e.g., medication preparation area) provided. Includes the surrounding healthcare environment (e.g., patient toilets). Patient zone: The patient and his or her immediate surroundings. Includes all surfaces that are temporarily and exclusively designated for that patient. General patient areas: Outpatient or ambulatory care wards and inpatient wards with patients admitted for routine medical procedures who are not receiving acute care (i.e., sudden, urgent or emergent episodes of injury and illness that require rapid intervention). Specialized patient areas: Inpatient wards or units (e.g., medication preparation areas) for high-dependency patients (e.g., ICUs), immunosuppressed patients (e.g., bone marrow transplant, chemotherapy), patients undergoing invasive procedures (e.g., operating rooms), or those who are regularly exposed to blood or body fluids (e.g., labour and delivery ward, burn units). Hemodialysis station: A hemodialysis machine with a chair or bed and connections to purified water and sanitary sewer. Stations in facilities with central delivery can also have acid concentrate and bicarb concentrate connections. Surgical field: Includes the patient zone in the operating rooms where asepsis is required. Only sterile objects and personnel are allowed in the surgical field. 6 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] ارسل الجر Ministry of Health High-touch surfaces: Surfaces, often in patient care areas, that are frequently touched by healthcare workers and patients (e.g., bedrails, over bed table, IV pole, door knobs, medication carts). Low-touch surfaces: Surfaces that are minimally touched by healthcare workers and patients (e.g., walls, ceilings, floors). Heavy-contamination area: Areas should be considered heavily contaminated if surfaces or equipment are regularly exposed to significant amounts of blood or other body fluids (e.g., birthing suite, autopsy suite, cardiac catheterization laboratory, burn unit, hemodialysis unit, emergency department, bathrooms of patients with diarrhea or incontinent). Moderate-contamination area: Areas should be considered moderately contaminated if surfaces or equipment are regularly contaminated with blood or body fluids (e.g., patient/resident rooms, bathrooms of continent patients) and the blood or body fluids are contained or rapidly removed (e.g., wet sheets). All client/resident/patient rooms and all bathrooms should be considered moderately contaminated. Light-contamination area: Areas can be considered lightly contaminated or not contaminated if surfaces are not exposed to blood or body fluids or items that have come in contact with blood or body fluids (e.g., lounges, libraries, offices). Terminal (discharge) cleaning: Cleaning and disinfection after the patient is discharged or transferred. Includes the removal of organic material and significant reduction and elimination of microbial contamination. Environmental cleaning services area: A dedicated space for preparing, reprocessing, and storing clean or new environmental cleaning supplies and equipment, including cleaning products and PPE. Access is restricted to cleaning staff and authorized personnel. Antimicrobial agent: Any agent that kills or suppresses the growth of microorganisms. Antiseptic: A substance that prevents or arrests the growth or action of microorganisms by inhibiting their activity or by destroying them. The term is used especially for preparations applied topically to living tissue. Bactericide: An agent that kills bacteria. 7|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] ارسل الجب Ministry of Health Detergent: A synthetic cleansing agent that can emulsify and suspend oil. Contains surfactant or a mixture of surfactants with cleaning properties in dilute solutions to lower surface tension and aid in the removal of organic soil and oils, fats, and greases. Disinfection: A thermal or chemical process for inactivating microorganisms on inanimate objects. Disinfectants: Chemical compounds that inactivate (i.e., kill) pathogens and other microbes fall into one of three categories based on chemical formulation: - low-level - mid-level - high-level Disinfectants are applied only to inanimate objects. All organic material and soil must be removed by a cleaning product before the application of disinfectants. Some products combine a cleaner with a disinfectant. Low-level disinfection: Inactivates most vegetative bacteria, some fungi, and some viruses in a practical contact time, but does not kill more hardy viruses (e.g. non-enveloped), and bacterial genus (e.g. mycobacteria), or bacterial spores. Mid-level disinfection (also intermediate-level disinfection): Kills inactive vegetative bacteria, including mycobacteria, most viruses, and most fungi, but might not kill bacterial spores. High-level disinfection: Kills all microorganisms, with the exception of small numbers of bacterial spores. Disinfectant fogging: Misting or fogging a liquid chemical disinfectant to disinfect environmental surfaces in an enclosed space. Disinfectant solution: A combination of water and disinfectant, in a ratio specified by the manufacturer. Three-bucket system (mopping): Floor mopping system for cleaning and disinfection. One bucket contains a detergent or cleaning solution, the second bucket contains disinfectant or disinfectant solution, and the third bucket contains clean water for rinsing the mop. Two-bucket system (mopping): Floor mopping system for cleaning only (not disinfection). One bucket contains a detergent or cleaning solution and the second bucket contains clean water for rinsing the mop. 8|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليكم السلام عليكم Ministry of Health Reusable patient care equipment: Devices that Health Care Workers (HCW) can reuse to diagnose and treat multiple patients (e.g., surgical forceps, endoscopes and stethoscopes). Microfiber cloths: Cloths are made from a tightly woven combination of polyester and polyamide (nylon) fibers. Hand hygiene (HH): Any action of hand cleansing to physically or mechanically remove dirt, organic material or microorganisms. Personal protective equipment (PPE): Personal protective equipment for health care providers and other staff refers to a variety of barriers used alone or in combination to protect mucous membranes, airways, skin and clothing from contact with infectious agents and chemical agents. Standard precautions: Are used for all patient care. Based on a risk assessment and make use of common sense practices and personal protective and other equipment that protects healthcare providers from infection and prevent the spread of infection from patient to patient. Transmission-based precautions: Are used in addition to Standard Precautions for patients with known or suspected infections. There are three categories: - Contact: intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, that are spread by direct or indirect contact with the patient or the patient's environment - Droplet: intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions - Airborne: intended to prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], M. tuberculosis, and possibly SARS-CoV). Biohazard spill kits If any biological spill occurs, including blood and other body substances (e.g., vomit, urine), this type of kit can be very effective. 9 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليك السلام عليك Ministry of Health Introduction Healthcare-associated infections (HAIs) are one of the most relevant public health problems worldwide. The role of the hospital environment as a reservoir of pathogens causing HAIs is confirmed by various published literature, healthcare-associated pathogens can survive on environmental surfaces for several months. The actual survival times in healthcare settings vary considerably based on factors such as temperature, humidity, and surface type. In a variety of healthcare settings, environmental contamination has been significantly associated with the transmission of pathogens in major outbreaks of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridioides difficile (C.diff), and more recently in protracted outbreaks of Acinetobacter baumannii. From all the above-mentioned data, it is obvious that environmental contamination in healthcare settings plays a significant role in the transmission of HAIs and outbreak incidents consequently. Therefore, environmental health related measures are a fundamental approach to infection prevention and control (IPC). It is a multifaceted intervention that involve cleaning and disinfection (when indicated) of the environment alongside other key program elements (e.g., leadership support, training, monitoring, and feedback mechanisms). To be effective, environmental health activities must be implemented within the framework of the facility IPC program, and not as a standalone intervention. It is also essential that IPC programs advocate for and work with facility administration and facility officials to operate and maintain adequate environmental infrastructure and resources to ensure that environmental health activities can be performed according to best practices. This guideline is tailored to provide a wide range of environmental health approaches that if implemented effectively will impact on health, safety, and quality of care provided to our patients. The intended audience of the document: All Health care workers (HCWs), Infection prevention & control staff, healthcare administrators, housekeeping and maintenance staff's department. Purpose of the document: The purpose of this guideline is to provide useful information for healthcare professionals in an effort to offer a safe environment to ensure that quality healthcare services will be administered to the patients. The recommendations herein provide guidance to minimize the risk for and prevent transmission of pathogens in the indoor healthcare facility environment, as well as to promote and standardize the implementation of environmental cleaning in patient care areas in all healthcare facilities. 10|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليكم السلام عليكم Ministry of Health Effective Environmental Health Program The key program elements for effective environmental cleaning & disinfection programs include the following components: 1. Organization /administration component. 2. Staffing and training of housekeeper component. 3. Policy and procedure component. 4. Quality monitoring and auditing component. 1. Organization /administration component: Administrative support Required support from the healthcare facility administration for the environmental cleaning & disinfection program includes a designated cleaning program manager or focal person. Additionally, an effective environmental cleaning & disinfection program requires a defined management structure, including organizational and reporting lines, and on-site supervision and an annual budget. 2. Staffing and training of housekeeping staff's component Staffing: The appropriate number of staffs and their training and education are key program elements. Cleaning staff should always have: ■ Written job descriptions. ■ Be familiar with their job descriptions and performance standards. ■ Supplies and equipment, including personal protective equipment (PPE), to perform their duties. ■ Reasonable working shifts. Education and training: ■ A training program must be developed according to the literacy level and work area. ■ Maintain training records, including dates, training content, and names of trainers and trainees. ■ A training program should be mandatory before staff can work independently within the healthcare facility. ■ Follow up and continues competency assessments (e.g., at least annually, before the introduction of new environmental cleaning supplies or equipment). ■ Training content should include, at a minimum: - General introduction to the principles of IPC, including the transmission of pathogens, personal protective equipment's (PPE), & hand hygiene. - Principles of environmental cleaning and disinfection based on national or facility environmental cleaning guidelines and policies. 11|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليك السلام عليك Ministry of Health - Safely prepare and use different detergents, disinfectants, and cleaning solutions - How to prepare, use, reprocess, and store cleaning supplies and equipment (including PPE). - Specific training for cleaning staff who could be responsible for cleaning procedures in specialized patient areas—particularly high-risk areas, such as intensive care units, operating rooms, and maternity units. - Specific environmental cleaning tasks for which they are responsible, including review of internal facility policy & procedure, and checklists. - How cleaning staff can protect themselves from pathogens. 3. Policy and procedure component key elements for implementing an effective environmental health program according to the development of facility environmental cleaning & disinfection policy, procedures, checklists, and other job aids. Provides the standards to which the facility will perform to meet best practices and include the following main standards: - Defined lines of accountability and functional reporting lines and responsibilities for all implicated staff. - Cleaning schedules for every patient care area and non-critical patient care equipment, specifying the frequency, method, the area intended to be cleaned, and staff responsible. - Special cleaning procedures for resistant organisms and outbreak management. - Only experienced housekeeping staff are allowed in the critical departments such as intensive care units. - Training requirements and performance standards for cleaning staff - Monitoring methods, frequency, and staff responsible. - list of approved cleaning products, supplies, and equipment and any required specifications on their use. - Use manufacturer's instructions in the following: preparation of environmental cleaning products (i.e., dilution, if applicable), reprocessing of reusable cleaning supplies, equipment and personal protective equipment, and reprocessing (i.e., cleaning and disinfection) of noncritical patient care equipment. - literacy levels and preferred language of cleaning staff should be taken into consideration. - Cleaning checklists are an interactive tool that can help ensure that all steps of cleaning and disinfection measures are completed. - Cleaning logs are job aids that can help guide the daily workflow of cleaning staff. 12 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] ارسل الجب Ministry of Health - Cleaning job aids include posters, pictorial guides, and other visual reminders for key cleaning tasks. - Make logs available in central locations or where the cleaning task occurs so that supervisory staff can manage them on a daily basis, along with staff (e.g., IPC focal person) responsible for periodic monitoring activities. Note: Externally Contracted Programs Environmental cleaning programs are increasingly implemented by external companies through a contract or service level agreement. Contracted staff, including cleaning staff and cleaning supervisors, should work closely with the environmental cleaning program focal person and IPC staff at the facility to ensure that environmental cleaning is performed according to best practices and facility policy. It is essential that all the standard program elements be described explicitly in the service level agreement with the external company, to ensure accountability. In general, the components of the service level agreement should be similar to the facility cleaning policy, and at a minimum should include: - An organizational chart for all contracted employees, including functional reporting lines and responsibilities. - The staffing plan for each patient care area, including contingency plans for additional staff. - The training content and frequency for contracted employees. - A summary of the cleaning schedules and methods for each patient care area, in line with the facility policy. - The methods for routine monitoring and feedback. - The supplies and equipment to be used. 4. Quality monitoring and auditing component - The responsibility for ensuring that cleaning of the environment in a health care facility is performed according to best practices and health care facility policy belongs to all staff involved in environmental cleaning, from the front-line environmental service workers to supervisors. - To ensure that this goal is met, a quality control program that includes regular assessments of cleaning and cleanliness is required. - There are currently a wide variety of approaches that can be used to monitor cleanliness in the health care environment. - Each approach addresses different aspects of cleaning and each has strengths and weaknesses. - Results of approaches used to monitor cleanliness should be used for education and training and to provide both positive and constructive feedback to environmental service workers. 13|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] اصيلاج Ministry of Health - Health care facilities should use at least one measure that directly assesses environmental cleaning process quality. - Results of cleaning audits should be used for the purposes of training and to provide positive and constructive feedback to frontline environmental service workers. - Aggregate results must be presented to relevant stakeholders, e.g., environmental service leadership, infection prevention and control, and the infection control committee. Common monitoring methods are either (see Table 1): - ■ Visual assessment ■ Environmental cleaning performance observation ■ Environmental marking ■ Adenosine triphosphate (ATP) 14 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] ارسل الجرج Ministry of Health Table 1: Methods Used to Monitor Cleaning and Cleanliness in Health Care Facilities <table><tr><td>Method</td><td>Description</td><td>Advantages</td><td>Disadvantages</td></tr><tr><td>Visual assessment</td><td>- Trained observer (e.g., Trained infection control personnel) assesses cleanliness of an area following cleaning.</td><td>- Easy to implement.- Allows feedback to environmental service staff.</td><td>- Results do not correlate with levels of microbial contamination.- Does not assure that a "health care clean" has been achieved.- Results may vary across different observers.</td></tr><tr><td>Environmental cleaning performance observation</td><td>- The environmental service supervisor observes environmental service workers performing cleaning.</td><td>- Easy to implement.- Useful to assess that facility procedure for cleaning are performed correctly.- Allows feedback to environmental service staff.</td><td>- Time-consuming.- Labour intensive.- Performance while observed may not be the same as performance when not observed.</td></tr><tr><td>Environmental marking</td><td>- Prior to cleaning, environmental surfaces are marked with an invisible tracing agent** that can only be seen using a revealing agent.- After cleaning, a trained observer can check to determine if the tracing agent was removed from the surfaces during cleaning.- Failure to remove the tracing agent from a surface suggests that the surface was not cleaned.</td><td>- Allows direct assessment of cleaning.- Allows assessment of which high- and low-touch surfaces are cleaned consistently and are omitted associated with rapid improvement when constructive feedback is provided.- Easy to implement.- Results easily understood.</td><td>- Does not directly measure microbial contamination.- Does not measure quality or intensity of cleaning (i.e., a single wipe will remove marker).- Does not assess adequacy of cleaning of unmarked surfaces.- Surface texture may affect the removal of tracing agent.</td></tr><tr><td>Adenosine triphosphate (ATP)*</td><td>- ATP is a substance found in all living cells.- Surfaces can be tested after cleaning to determine the quantitative level of ATP present.</td><td>- Allows assessment of residual organic material present after cleaning.- Provides quantitative result.- Easy to implement.- Provides quick and direct feedback.</td><td>- Not a direct measure of microbial contamination.- Some cleaning products may interfere with the test (e.g., microfiber, bleach, hydrogen peroxide, quaternary ammonium compounds).- Does not assess the adequacy of cleaning of unmarked surfaces.</td></tr></table> 15|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليك السلام عليك Ministry of Health * Adenosine triphosphate (ATP) is a substance present in all living cells and some organic materials, including food, and body fluids as the presence of ATP on a surface indicate that organic material remains on the surface thus while the absence of ATP suggests that there is little microbial contamination of a surface, the presence of ATP could represent either microbial (viable and dead) contamination or other organic material. ** A tracing agent (e.g., fluorescent material, chemical tracer) marks predetermined items and surfaces before cleaning. After cleaning, a trained observer uses a detecting agent (e.g., ultraviolet light, enzymatic detector) to determine if any tracing agent is left. The observer counts the items that still show tracing agent and gives a score based on how many were cleaned completely, partially, or not at all. Structured monitoring programs ensure that environmental cleaning is conducted according to best practices. There must be organizational support and resources to address deficiencies identified during monitoring activities. Use a standardized methodology for monitoring, apply it on a routine basis, and provide timely feedback to cleaning staff and program leadership. Promptly return monitoring results as a feedback mechanism to cleaning staff, so they can make immediate improvements to practice, and management (e.g., cleaning program manager), to make more general improvements to the cleaning program. Environmental Cleaning and Disinfection Required Supplies, Equipment's, Health Care and Utility Room Design A. In order to support the best environmental cleaning & disinfection practices, the following general requirements are essential: Environmental surfaces - Environmental services, infection prevention & control, and occupational health should be consulted as key stakeholders at the planning stage of construction and renovation and must be involved in decision-making regarding choices of equipment, furniture and finishes in health care settings. - All healthcare settings must have a process in place to ensure that all selected surfaces, finishes, furnishings and equipment are cleanable and compatible with the hospital disinfectant used by the healthcare facility. - If equipment, furnishings, finishings, or surfaces are damaged and cannot be effectively cleaned, they must be repaired, replaced or removed from use within clinical areas. - When selecting surfaces for use in clinical areas within health care settings, surfaces with the following characteristics are recommended, as these characteristics minimize the risk of microbial contamination: a) Cleanable b) Easy to maintain & repair c) Resistant to microbial growth 16|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] ارسل الجب Ministry of Health d) Nonporous e) Seamless - Wood is an example of an organic material that contains moisture, porous and should be avoided in care areas. Cloth furnishing: - Microorganisms have been shown to survive on porous fabrics such as cotton, cotton terry, nylon and polyester and on porous plastics such as polyurethane and polypropylene. - Cloth furnishings can harbour higher concentrations of fungi than nonporous furnishings additionally, bacteria cannot be effectively removed from the surfaces of upholstered furniture. - Stuffing and foam cannot be effectively disinfected if breaks in fabric or leaks of body fluids or spills have occurred. - Cloth surfaces such as curtains, pillows, mattresses or soft furnishings are used in clinical areas, cloth surfaces with the following characteristics are preferred, as these characteristics minimize the risk of microbial contamination: - Seamless (where possible) or have double-stitched seams. - Easy to access (e.g., removable covers) for cleaning. - Have foam cores that are resistant to mold. - Durable and able to tolerate repeated cleaning with detergents and disinfectants, without damage. - Quick drying. - Easy to maintain, repair or replace. - Covered with fluid-resistant fabric. Bedside privacy curtains: - Privacy curtains are commonly used in health care settings, and they rapidly become contaminated with microorganisms. - Privacy curtains are considered high-touch surfaces. - The use of privacy curtains with antimicrobial properties has not been proven to reduce infection risk and does not eliminate the risk of contamination with microorganisms. - Bedside curtains should be washed properly and drying temperatures must be reached and appropriate chemicals must be ensured. - Privacy bedside curtains must be removed, cleaned and disinfected immediately if they become contaminated with blood or body fluids, or are visibly soiled. - Privacy bedside curtains used for all patients including patients under isolation precautions should be changed following discharge or transfer of the patient and before a new patient is admitted to that room or bed space. 17 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] äulläjlg Ministry of Health - For patients with extended stays, health care facilities should consider changing privacy curtains regularly (on a routine schedule), and when visibly soiled, or at least monthly. Carpeting: - Carpeting has been associated with an increased risk of health care-associated infection rates in immunocompromised populations. - Carpets collect dust and debris and are more difficult to maintain than floors. Because the dust in carpets contains fungal spores that may induce asthma attacks and cause fatal infections in immunocompromised patients, carpets are not recommended - Compared to hard-surface flooring, however, carpeting is harder to keep clean, especially after spills of blood and body substances. B. Soiled (dirty) and clean utility/supply rooms: - It is an essential environmental cleaning principle that clean and soiled (i.e., dirty, used) supplies and equipment should be clearly separated. - Each patient care area should be equipped with a room dedicated as a soiled utility room. - A separate room shall be dedicated to the storage of clean supplies and equipment. - A soiled utility room is used for the temporary storage of supplies and equipment that will be removed for cleaning, reprocessing or disposal. Soiled utility rooms characteristics: - Should be well-ventilated and illuminated (lighting or window access) - Labelled with a biohazard sign on the door - Physically separate from other areas, including clean supply/storage areas. - Have a work counter and flushing-rim clinical sink (i.e., hopper) with a hot and cold mixing faucet. - Have a dedicated hand washing sink with both hot and cold running water. - A separate utility sink is also required if the soiled utility room will be used for rinsing or removal of gross soiling of medical instruments or equipment. - Have personal protective equipment available to protect staff during cleaning and disinfecting procedures. - Be adequately sized within the unit and located near the point of care. - Soiled utility rooms should not be used to store unused equipment. - Have printed copies of the SDS for all environmental cleaning products, manufacturer's instructions, and job aids for the preparation of cleaning and disinfectant solutions. - Never contain personal clothing or grooming supplies, food or beverages. 18 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليك السلام عليك Ministry of Health Clean utility room characteristics: - Separate from and have no direct connection with soiled workrooms or soiled holding areas. - Keep supplies free from dust and moisture and stored off the floor. - Be adjacent to usage areas and easily available to staff. - Be equipped with a work counter and dedicated hand washing sink if used for preparing patient care items. C. Cleaning equipment: - Cleaning equipment requires careful and regular cleaning and disinfection to avoid inadvertent cross-transmission of microorganisms during subsequent use. - Tools and equipment used for cleaning and disinfection must be single-use and, if multi-use should be cleaned and dried between uses (e.g., mops, buckets). - Cleaning tools and equipment such as mop used in a room or bed space on isolation precautions must be either disposable and discarded after use, or if re-usable, changed immediately after use and transport to the laundry. - If the mop heads and cleaning cloths should be changed and laundered daily or after use (if used less frequently than daily) and changed when visibly soiled. - All washed mop heads must be dried thoroughly before storage. - Cleaning equipment shall be well maintained, clean and in good repair. Surface cleaning supplies: Portable containers for environmental cleaning products (or solutions) should be clean, dry, appropriately sized, labelled, and dated. Surface cleaning cloths should be cotton or microfiber (disposable wipes can be used if resources allow). Have a supply of different colored cloths to allow color-coding: for example, one color for cleaning and a second color for disinfecting. Color-coding also prevents cross-contamination between areas. Floor cleaning supplies: ■ Mop heads or floor cloths should be cotton or microfiber. ■ Use a cart or trolley with two or three buckets for the mopping process. ■ It is highly recommended to display a wet floor/caution sign before starting. 19 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليك السلام عليك Ministry of Health D. Storage of cleaning supplies: - All chemical cleaning agents and disinfectants should be appropriately labelled and stored in a manner that eliminates exposure, inhalation, skin contact or personal injury. - A safety data sheet (SDS) shall be readily available for each item. - Equipment used to clean toilets (e.g., toilet brushes, toilet swabs) should not be carried from room to room. - Toilet cleaning and disinfecting equipment should be discarded when the patient leaves or sooner if required. - In multi-bed rooms, a system should be developed for the replacement of toilet brushes on a regular basis or as required. - When choosing a tool for cleaning toilets, consideration should be given to equipment that will minimize splashing. Remember: Microfiber Versus Cotton: Microfiber cloths are often preferred over cotton for both cleaning cloths and mop heads because microfiber absorb more dirt and microorganisms than cotton. However, microfiber cloths can be damaged by high pH and therefore not compatible with all disinfectant products (especially chlorine-based). They need to be laundered separately from cotton cloths/linens, which could be expensive. Disinfectant or Detergent-Disinfectant Wipes: Prepared (ready-to-use) wipes that are saturated with an appropriate disinfectant or detergent-disinfectant product can be used as an alternative to cotton or microfiber cleaning cloths. It is important to ensure that they are stored appropriately with the lid closed, so the wipes remain wet. Discard wipes if they are no longer saturated. Follow manufacturer's instructions for storing wipes and for instructions for use (e.g., recommended contact times). E. Cleaning carts and trolleys - Cleaning carts and trolleys provide several benefits, such as the ability to carry and safely manage all the essential cleaning supplies and equipment and increased occupational safety for cleaning staff. - Two-bucket system (routine cleaning): one bucket contains a detergent or cleaning solution and the other contains rinse water (see Figure 1). 20|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليكم السلام عليكم Ministry of Health Figure 1: Two Bucket System - Three-bucket system (for disinfection): one bucket contains the detergent or cleaning solution; one contains rinse water and one the disinfectant or disinfectant solution. The rinse water bucket allows the mop to be rinsed and wrung out before it is re-dipped into the prepared solution. This extends the life of the solution (i.e., fewer changes are required), which saves both time and material costs (see Figure 2) Figure 2: Three Bucket System - Stock cleaning carts with sufficient quantities of supplies (e.g., cleaning cloths, cleaning solutions) to avoid the need to return for more supplies in the middle of cleaning in a particular patient care area. 21|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليك Ministry of Health - Should have a separation between clean and soiled items. - Should never contain personal clothing or grooming supplies, food or beverages. - Should be thoroughly cleaned at the end of the day. - Shall be equipped with a locked compartment for storage of hazardous substances, and each cart shall be locked at all times when not attended, and stored, when not in use, within a locked housekeeping closet. F. New equipment/product purchases The administration of the health care setting is responsible for ensuring and verifying that any item used in the provision of care to clients/patients/residents is capable of being cleaned and disinfected according to current standards and guidelines. There are different kinds of products available for environmental cleaning, which all have distinct properties, advantages, and disadvantages to their potential use in healthcare. Method of selecting the environmental cleaning products (e.g., detergents, disinfectants): - Develop and maintain a master list of facility-approved environmental cleaning products in the facility cleaning policy, as well as a list of approved suppliers (i.e., manufacturers, and distributors). - Minimize the number of different environmental cleaning products in use at the facility. - Manage environmental cleaning products according to the product's material safety data sheet (MSDS). Display the MSDS where these products are stored and prepared. - Prepare cleaning and disinfectant solutions according to the manufacturer's instructions. Preparing higher-strength concentrations or diluting beyond recommendations may pose an unnecessary risk to patients, staff, visitors, and the environment. - Ensure that environmental cleaning products are selected that do not damage the surfaces, equipment intended to be cleaned and disinfected and are compatible with them. - Ensure that standard operating procedures or instructions are available for the preparation, use, and disposal of environmental cleaning products. - Must be approved by MoH infection prevention and control, occupational health and safety, and environmental services. - Must be used according to the manufacturers' recommendations (e.g., for dilution, temperature, water hardness, contact time, etc.). - Must be dedicated for healthcare facilities use. The process of selecting cleaning and disinfecting agents - A multidisciplinary team should evaluate the cleaning and disinfectant products and selection will be made accordingly. Team members should include infection 22 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] اطرف الجز Ministry of Health preventionist, hospital leaders, housekeeping staff, occupational health staff, medical supply department staff, clinical staff, and other environments of care professionals (see Table 2). - Review manufacturers' instructions and relevant national guidelines before purchasing cleaning and disinfectant. Consequently, the cleaning and disinfectant products can be properly used and will not pose a patient or health care worker safety risk. - Although the complexity of the health care environment may require the use of more than one disinfectant product, every effort should be made to limit the total number of different products in use. This will simplify the cleaning process, minimize the training requirements for environmental service workers and reduce the potential for errors. - Disinfectants are only used after cleaning and are not substitutes for cleaning unless they are a combined detergent-disinfectant product. Before disinfecting, use a cleaning product to remove all organic material and soil (see Table 2). - Low-level disinfection is generally adequate for environmental cleaning procedures, but there are specific cases where intermediate-level disinfection with sporicidal properties (e.g., C. difficile) is required. 23|Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] احمل الجر Ministry of Health Table 2: The Criteria for Selection of Disinfectant: <table><tr><td>The properties of the disinfection</td><td>The common Action</td></tr><tr><td>Broad-spectrum</td><td>- Active against the microorganisms encountered in the health care setting.</td></tr><tr><td>Fast-acting</td><td>- Produce a rapid kill.</td></tr><tr><td>Not affected by environmental factors</td><td>- Active in the presence of organic matter (e.g., blood, sputum, feces) and compatible with soaps, detergents, and other chemicals.</td></tr><tr><td>Nontoxic</td><td>- Low irritancy and allergenic characteristics.- Not to be harmful to the user or patient.</td></tr><tr><td>Surface compatibility</td><td>- Not corrode instruments and metallic surfaces.- Not cause the deterioration of cloth, rubber, plastics, and other materials.</td></tr><tr><td>Residual effect on treated surfaces</td><td>- Leave an antimicrobial film on the treated surface.</td></tr><tr><td>Ease of use</td><td>- Easy to use with clear label directions.- The disinfectant should be simple to prepare and use at the required concentration.- Require little or no mixing or diluting.- The ability of the disinfectant to act as a cleaner and disinfectant (e.g., one-step cleaner disinfectant.)</td></tr><tr><td>Wet contact time</td><td>- The disinfectant should have a sufficiently short contact time and should keep surfaces wet long enough to ensure that the contact time is met.- Active at room temperature with a short contact time.</td></tr><tr><td>Odorless</td><td>- A pleasant odor or no odor to facilitate its routine use.</td></tr><tr><td>Economical</td><td>- Not be prohibitively high in cost.</td></tr><tr><td>Solubility</td><td>- Be soluble in water.</td></tr><tr><td>Stability</td><td>- Stable in concentrate and use-dilution.</td></tr><tr><td>Cleaner</td><td>- Good cleaning properties.</td></tr><tr><td>Environmentally friendly</td><td>- Damage the environment on disposal.</td></tr></table> 24 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليك السلام عليك Ministry of Health Table (3): Types of Approved Disinfectants & Detergents Used for Healthcare Environments: <table><tr><td>Disinfectant</td><td>Area / Surfaces</td><td>Example of Items / Surfaces</td><td>Steps</td></tr><tr><td>Hospital Approved Hydrogen Peroxide 3-5 %</td><td>· Isolation Rooms· Critical Care Unit· Surgical Ward· Operating Theatre</td><td>HIGH-TOUCH ENVIRONMENTAL SURFACES: Bed rails, bedside tables, lockers, doorknobs, computers, blood pressure cuffs, pulse oximeters, Crutches, keyboards, trolleys, stethoscopes, intravenous pumps, stands etc.</td><td>- All non-critical items if not visibly clean should be cleaned with [soap and water] before using any disinfectant on daily basis and after patient discharge.- Wear PPE (disposable non-sterile gloves and mask).- Spray the solution on the surface/equipment and allow it to air dry. (pre-cleaned surface) (Contact Time: 5 minutes).</td></tr><tr><td>Hospital Approved Quaternary Ammonium Chloride (Disposable Wipes)</td><td>Non-Critical Surface Areas</td><td>HIGH-TOUCH ENVIRONMENTAL SURFACES: Bed rails, bedside tables, lockers, doorknobs, computers, blood pressure cuffs, pulse oximeters, crutches, keyboards, trolleys, stethoscopes, intravenous pumps, stands etc.</td><td>- Wear PPE.- Pick up the wipe from the container.- Wipe the equipment/surface to thoroughly wet in one direction with friction.- Allow the surface to air dry to ensure greater contact time for killing pathogens. (Contact time minimum 1-2 minutes).- Discard the wipe after ‘one usage’ and ‘one direction’.</td></tr><tr><td>Hospital Approved 70% Isopropyl Alcohol (Disposable Wipes)</td><td>Non-Critical Patient Care Items / Medical Equipment</td><td>Patient care equipment which are not compatible with Quaternary Ammonium Chloride wipes.</td><td>- Wear PPE.- Pick up the wipe from the container.- Wipe the equipment/surface to thoroughly wet in one direction with friction.- Allow the surface to air dry to ensure a greater contact time for killing pathogens. (Contact time minimum 1-2 minutes).- Discard the wipe after ‘one usage’ and ‘one direction’.</td></tr></table> 25 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] اصيل alsjq Ministry of Health <table><tr><td>Disinfectant</td><td>Area / Surfaces</td><td>Example of Items / Surfaces</td><td>Steps</td></tr><tr><td rowspan="2">Hospital Approved Sodium Hypochlorite 5.25</td><td>(C. Difficile & OR Rooms)</td><td>Floor & Toilet</td><td rowspan="2">- Use 1:10 dilution (5000ppm) - (400ml + 1 gallon of water) - Contact time 20 minutes</td></tr><tr><td>(Non-C. Difficile Room)</td><td>For Toilet</td></tr><tr><td>Hospital Approved Quaternary Ammonium Chloride (Liquid)</td><td>Non-Critical Surface Areas</td><td>For floors, walls and ceilings of Isolation and Non-Isolation patients' room during daily cleaning and terminal cleaning</td><td>- Use the disinfectant in accordance with the manufacturer's instructions (for the use and contact time).</td></tr><tr><td colspan="4">Note:Please follow the manufacturer's instructions for the cleaning and disinfecting direction and contact time. In the absence of a manufacturer's cleaning instructions, follow certain procedures:1. All Surfaces/ equipment should be physically clean prior to disinfection either by disinfectant by wipe or by spray.2. This may be followed by an application of an EPA-registered hospital-approved disinfectant after careful evaluation.3. Contact time is the time needed for the germicide solution to remain wet on the surface to achieve disinfection of the stated kill claim(s) on the manufacturer's label.</td></tr></table> Note: For further information; Refer to the Approved Infection Control Supplies, Equipment and Disinfectants Specifications Guidelines, 1st Edition, GDIPC, MOH, 2021 26 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 السلام عليكم السلام عليكم Ministry of Health Environmental Cleaning and Disinfecting Methods: A. General overview of the environmental surfaces: - Although any surface may become contaminated, the risk and extent of contamination are greater for surfaces and items that are handled frequently by the hands or gloves of staff or patients as compared to surfaces that are less frequently handled or touched. - Surfaces within the health care setting and in particular within the patient's environment can be classified as high- and low-touch surfaces, as follows: - High-touch surfaces are those that have frequent contact with hands, examples include (but are not limited to) doorknobs, elevator buttons, telephones, call bells, bedrails, light switches, toilet flushes, monitoring equipment, IV infusion pump, end-of-bed table and the edges of the privacy curtains. - Low-touch surfaces are those that have minimal contact with hands, examples include (but are not limited to) floors, walls, ceilings, and window sills. - High-touch surfaces in care areas require more frequent cleaning and disinfection than minimal contact surfaces. - Cleaning and disinfection should be performed at least daily and more frequently if the risk of environmental contamination is higher. - Low-touch surfaces require cleaning on a regular basis, when soiling or spills occur, and when a patient is discharged or transferred. B. Cleaning & disinfection techniques: • Daily routine cleaning of the patient room or bed space: The health care clean of patient rooms should follow a standard, methodical format that includes each of the following elements: a) Routine practices and additional precautions. b) Perform hand hygiene before entering the room or bed space (for multi-bed rooms). c) Put on additional personal protective equipment if required to avoid exposure to blood or body fluids or if indicated by additional precautions signage. d) As much as possible, work from clean to dirty (to avoid moving dirt and microorganisms from dirty areas to cleaner areas) and from high to low (to avoid having dirt or microorganisms drip down and re-contaminate areas already cleaned). e) Hand hygiene is required every time the room or bed space is re-entered and every time upon leaving the room or bed space. 27 Best Practices of Environmental Health for Prevention & Control of Infections in Healthcare Facilities Guidelines-August 2022 - Version 1.1 [Non-Text] ارسل الجب Ministry of Health f) If gloves or other personal protective equipment are worn, they must also be removed every time you leave the room or bed space, and new personal protective equipment must be put on when re-entering the room or bed space. g) In-room bathrooms should be cleaned last, after completing room cleaning, based on the principle of cleaning from clean to dirty. • Discharge/Transfer patient room cleaning (Terminal Cleaning): - When a patient is discharged, transferred or dies, the room or bed space must be cleaned and disinfected thoroughly before the next patient occupies the space to prevent the transfer of microorganisms to the new patient. - Cleaning and disinfection upon discharge include several steps not required during routine daily cleaning. - In general, clinical staff are responsible for: a) Removing or discarding medical supplies. b) Emptying items containing blood or body fluids and removing items or equipment potentially contaminated with blood or body fluids (e.g., discarding IV bags and tubing and urinary catheter collection bag, emptying bedpans/commodes/urinals/washbasins, emptying suction bottles. c) Disposal of personal articles left by the patient/resident including toiletries (e.g., soap, creams, razors, toothbrushes, comb, books, magazines, toys). d) These items can transmit microorganisms to other patients and must be taken with the patient on discharge/transfer or discarded. - Floor cleaning: - Floors in health care settings may be comprised of a number of materials, depending on the location of the flooring and the patient population in the vicinity. - It is important to review the manufacturer's recommendations for cleaning a particular type of flooring before developing cleaning protocols. - Floor cleaning consists of dry dust mopping to remove dust and debris, followed by wet mopping with a detergent to clean. - Floors are low-touch surfaces that rarely come in contact with the hands of patients or health care providers. - Dry mopping may be done with microfiber mops or pads to reduce the dispersal of dust and debris. - A clean mop pad should be used for each room. …(85,996 more chars)