Four steps for clean hospitals: assessment, planning, disinfection, drying
Cleaning and disinfecting surfaces and instruments in hospitals has gained increased importance with the realization that pathogens survive in the healthcare environment and contribute to the risk of nosocomial infections. The environment allows for the transmission of the most dangerous microorganisms, which can persist on surfaces for weeks and represent a transmission risk to both patients and staff. Environmental screening confirms repeated contamination of objects, equipment, and general areas in bed spaces and rooms of colonized or infected patients, as well as in many clinical areas within a healthcare institution. Thus, hospital hygiene is crucial for preventing the spread of healthcare-associated infections.
The places with the highest risk of contamination are those closest to the patient. Medical staff, visitors, and the patients themselves touch these surfaces and transfer them to other locations, which increases the risk of further transmission.
Hospital hygiene – why is it important?
While maintaining cleanliness in hospitals was initially considered an aesthetic necessity, it is now accepted that frequent and well-targeted cleaning can reduce the bioburden in the healthcare environment and the associated risk of nosocomial infections. Over the last decade, evidence has accumulated in support of cleaning, alongside more traditional infection prevention activities, such as hand hygiene, barrier nursing, screening, and isolation.
Indeed, even exemplary hand hygiene will not protect patients against acquiring a specific pathogen if their room was previously occupied by a patient with the same pathogen. The cleaning process itself is the subject of debate regarding the methods that should be used, the frequency with which it should be performed and by whom, as well as the choice of equipment, liquids and cleaning wipes, monitoring, and risk-based standards. Cleaning practices vary considerably, even within the same hospital, and they depend heavily on available resources and managerial support.
Cleaning staff receive little or no training for what they do, and a systematic course on best practices, with built-in risk assessment for themselves as well as for staff and patients, should be mandatory. Best practices primarily target cleaning rather than the attention of healthcare staff, and as such, they prioritize items and furniture in the bed space rather than clinical equipment.
These statements are supported by published evidence obtained from initial research, or basic principles of hygiene if not, and they provide a practical approach to mitigating the risk of environmental contamination of surfaces in the patient's proximity.
The four steps for hospital cleaning
Why do we need a guide for routine room cleaning and maintaining hospital hygiene? Primarily, because the repeated application of a sequential cleaning system would provide a time-efficient method for decontaminating a hospital room. We already know that surfaces are regularly missed during cleaning and that the time spent on sanitation procedures does not correlate with the thoroughness of cleaning. A practical guide would improve the cleaning of high-risk areas near patients and could impact the risk of contamination with viruses or bacteria.
An explanatory guide could be a valuable tool for cleaning staff, providing them with clarity and direction regarding their cleaning tasks. This information could include indications as to what to do, when to do it, and why it is important to do it. Focusing on unoccupied rooms could be an effective strategy, as these are less exposed to potential sources of contamination, such as patients, visitors, or clinical equipment.
Indeed, unoccupied rooms are easier to clean because they are not traversed by patients, visitors, or medical equipment. However, even in these spaces, there is a low risk of infection for the cleaning staff, especially in contexts where patients are present regularly. Patients can interact with surfaces without ensuring they sanitize their hands beforehand, which increases the risk of contamination and the spread of infections.
Special disinfectants, such as KLINOSEPT® – RTU rapid surface disinfectant, can be effective tools for the proper cleaning and disinfection of surfaces in these sensitive environments. Using these disinfectants can help eliminate pathogenic microorganisms and reduce the risk of infection transmission in hospitals and other medical facilities. Thus, explanatory guides and the use of special disinfectants can contribute to ensuring a clean and safe environment for patients, medical staff, and visitors.
The four recommended steps for good cleaning and sanitation are 1) assessment, 2) planning, 3) cleaning and disinfection, 4) drying.
Step 1: Assessment
A visual assessment is the first stage of the cleaning process. Each cleaning staff member should inspect the area and consider general conditions and the degree of visual contamination before starting a cleaning task. Conscious attention to visual dirt, spills, and trash in the room will assist in the subsequent sanitation of the space.
This initial assessment requires adequate lighting, whether natural or artificial. Staff should also assess the cleanliness of a room based on ambient temperature, odor, and the patient's condition; patients may be asleep, absent, immobile, mobile, undergoing a clinical procedure, or unconscious. Medical staff and/or visitors may be present in the room. It is important to consider noise control; cleaning activity and/or equipment may disturb a sick patient and disrupt visits or clinical care.
Step 2: Planning
The first action is hand washing. Hands should preferably be washed with water and liquid soap. Next, furniture and beds may need realigning if they block access to areas intended for cleaning. It may be necessary to raise the bed rails to protect the patient before raising the bed for easier access to the underside. It may also be necessary to reposition clinical equipment (e.g., IV drip stands, ventilators, respiratory aids) or patient devices (e.g., catheter bags). Surfaces near the patient pose the highest risk of contamination, so cleaning locations such as the bedside cabinet and table should not be omitted just because they are covered with patient belongings.
Once the room or bed space has been organized for access, trash cans must be checked and emptied, and visible waste on the floor and other surfaces must be removed.
Final preparations include replacing trash bags, soap, paper towels, and toilet paper; and collecting discarded dishes, glasses, cutlery, and water pitchers, unless these duties are assigned to other staff. Similarly, soiled linens and towels must be removed and placed in appropriate containers, unless linen removal is handled by other staff.
At this point, staff can collect cleaning equipment and supplies and bring them into the room. Cleaning staff should have sufficient water, clean cloths or wipes, and mop heads available, with clear instructions on how to handle disposable and non-disposable items. KLINTENSIV® – Disinfectant wet wipes for surfaces
Step 3: Surface cleaning
Hospital hygiene begins with the correct cleaning of critical and non-critical areas. Cleaning refers to the removal of dirt from surfaces through physical wiping or washing. Cleaning should always precede the disinfection stage, as the presence of dirt will hinder the activity of disinfectants. Cleaning and disinfection become simultaneous when using wipes impregnated with disinfectant.
Detergent is used for dirt removal; the disinfectant is for eliminating germs. Wipes impregnated with disinfectant must be used according to the manufacturer's instructions, including regarding drying time.
Increased attention will be paid to objects frequently used by multiple people, such as faucets, handles, nurse call buttons, grab bars, toilet roll holders, etc. Cleaning the floor is the final task to be completed.
Step 4: Surface drying
The final stage includes physical drying using paper towels or clean cloths. The sanitation process is not complete until all surfaces are completely dry. Contact time is usually considered critical for the disinfection stage. Reusable equipment must be inspected, cleaned, and dried before being used. If the surfaces look and feel dry, then the furniture (and bed) can be repositioned, and the patient's belongings should be returned to the top of the cabinet or bedside table.
This fourth stage should also include the cleaning staff's assessment of the overall cleanliness of the space. Any issues related to cleaning should be reported. This would include failure to complete due to lack of access; patient condition; or faults or potential defects in cleaning objects or equipment.
