Principles for cleaning and disinfecting the non-critical hospital environment

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 environmental cleaning and decontamination is heightened when these processes are used as part of transmission-based precautions and infection outbreak management. KLINTENSIV® – Ready-to-use surface disinfectant is a product specially created to prevent the spread of microorganisms in work areas.

Cleaning procedures should be considered an essential part of a comprehensive hospital infection prevention program, with protocols in place to support good performance, and should include strategies for product optimization, technique, auditing and feedback, staff education, and communication. National health safety and quality standards require healthcare institutions to have processes in place to maintain a clean and hygienic environment.

Non-critical and critical hospital spaces

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

1. Critical medical devices: These are medical pieces of equipment that come into direct contact with a patient's tissues or vascular system, thus 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 penetrates body tissues or the bloodstream. These devices require rigorous disinfection and sterilization between uses to prevent the transmission of infections.

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

Key principles for the surface cleaning process in clinics and hospitals

Detergent use

A detergent is an active chemical substance, also known as a surfactant, that helps remove dirt and organic matter from surfaces. KLINOZYME – Concentrated tri-enzymatic detergent is an example of an effective detergent, specially designed to ensure proper cleaning and decontamination of medical surfaces and 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 the detergent's usage directions to achieve the best results. After cleaning, it is essential to allow surfaces to dry completely, as excessive moisture can promote the growth of microorganisms 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 removing stubborn dirt and eliminating 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. Even after they have been cleaned, floors can be quickly recontaminated by dust particles, debris from footwear, or medical equipment wheels. These microorganisms can remain active on the floor surface, but the risk of transmitting infections to patients is considered minimal in this context.

Using a special floor cleaning solution can help remove dirt and microorganisms from their surface, ensuring a more hygienic environment in healthcare facilities. Using a floor cleaning solution can provide an additional level of cleaning and disinfection, thereby helping to maintain a safe and clean environment for patients and medical 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, thus forming 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 ensure effective disinfection of various surfaces in healthcare facilities. This disinfectant is prepared for immediate use and can be applied directly to surfaces without requiring dilution or other preparatory procedures. Regular use of a disinfectant like KLINTENSIV® can contribute to reducing the risk of infection transmission and maintaining a hygienic environment in healthcare facilities.

Disinfection must always be performed after and in addition to cleaning with detergent.

It is necessary to use a disinfectant:

• for cleaning surfaces (including floors) suspected or known to be contaminated with a multi-resistant organism; an organism with outbreak potential; and/or other potentially infectious materials, including blood and other body fluids.
• in high or extreme risk environments (in accordance with local risk assessment).
• for discharge cleaning after caring for a patient with multi-resistant organisms or other infectious diseases.

The routine use of a disinfectant in other areas of a healthcare facility or for cleaning all discharges should be established locally by the infection prevention and control team after conducting a risk assessment that takes into account local disease epidemiology.

Choosing a disinfectant

When evaluating and selecting a disinfectant within a healthcare facility, factors such as concentration, wet contact time, compatibility, safety, ease of use, and value for money must be considered.

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

Considerations regarding disinfectant use

• Care must be taken to ensure that the correct chemical product is used properly and in accordance with the manufacturer's specifications.
• When using a disinfectant, ensure 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 dirty; and immediately after cleaning up blood and body fluid spills.

Routine practices

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

• hand hygiene
• point-of-care risk assessment
• personal protective equipment
• handling of patient care items and equipment
• waste and sharps handling
• environmental cleaning

Hand hygiene is the most important factor in preventing the transmission of microorganisms. Perform hand hygiene according to the techniques recommended by authorized institutions.

Perform a point-of-care risk assessment before cleaning a patient's 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 into contact with blood and body fluids, excretions, or secretions and to handle dirty or potentially contaminated items.

Wear disposable gloves for routine cleaning activities.

If reusable gloves are required (intended for use when a glove with higher physical protection is needed, e.g., recommended in the manufacturer's instructions for use, or for cleaning rough surfaces):

• they must be assigned to a specific staff member;
• they must be cleaned in accordance with the manufacturer's instructions;
• ensure the gloves are dry inside and out before being reused;
• inspect the material for its intended purpose and discard it if it shows signs of damage, peeling, discoloration, tears, holes, or punctures.

Wear additional equipment, such as gowns, eye protection, and masks, if necessary to protect skin and clothing from splashes or sprays, for example, when cleaning large spills.

Cleaning and disinfection methods

Cleaning is the physical removal of dirt and debris through the mechanical action of wiping with a clean, damp cloth or mop. Surfaces must be cleared of visible dirt before they can be disinfected, as dust, dirt, and organic matter interfere with the disinfectant's efficacy.

Disinfection is the process by which pathogenic microorganisms are neutralized or destroyed, preventing them from causing disease. This process can be achieved 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 entire contact time recommended by the manufacturer to ensure effective disinfection.

An example of a high-performance concentrated disinfectant is SPORYCIDE® – High-level concentrated disinfectant. It is designed to provide powerful action against a wide spectrum of pathogenic microorganisms, contributing to higher hygiene levels in healthcare settings. Proper use of a disinfectant like SPORYCIDE® can be crucial in preventing infection transmission and maintaining a safe environment for patients and medical staff.

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

Enzymatic detergent-disinfectants are special formulations containing active enzymes that help break down and effectively remove proteins, fats, and other organic matter, such as blood or secretions. These products are frequently used in medical settings and other fields where hygiene is crucial, such as the food industry or the service sector.

Using an enzymatic detergent-disinfectant can be an effective option for cleaning and disinfecting surfaces, ensuring a safe and hygienic environment in various fields of application. It is important to follow the manufacturer's instructions for use to achieve the best results in the sanitization process.

Before cleaning:

• gather the necessary cleaning supplies;
• remove unnecessary items from the surfaces to be cleaned;
• clean reusable equipment before removing it from the patient's room;
• collect and handle waste bags from the top;
• check sharps containers and replace them when they are 3⁄4 full or reach the fill line;
• do not overfill.

Prepare cleaning and disinfection solutions:

• dispense cleaning and disinfection products into clean, dry, properly sized containers that are clearly labeled and dated. Discard the solution after the expiration date.
• check the solution concentration according to institutional policy and the manufacturer's instructions, using test strips recommended by the manufacturer, at least once a day or more frequently, depending on site requirements.

During the cleaning and disinfection process:

• follow the manufacturer's instructions regarding contact time for disinfection;
• use a clean cloth for the cleaning or disinfection solution. Do not dip a used cloth into the cleaning or disinfection solution (double-dipping);
• begin cleaning from the cleanest areas toward the dirtiest areas. Bathrooms should be cleaned last; move from surfaces touched less frequently to those touched more frequently.

Cleaning and disinfection products and equipment

• Use only professional cleaning and disinfection products and equipment intended for use in an in-hospital setting. Do not use unapproved products, such as household cleaners.
• Select the appropriate product for the intended task, e.g., cleaning or disinfection.
• 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 dirt, but they do not replace the cleaning process.

Do not mix different types of cleaning/disinfecting products (unless specified by the manufacturer), as the chemicals can react with each other, for example, 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:

• Care environment items that cannot tolerate soaking (multiple wipes are required for disinfecting large pieces of non-critical equipment).
• Small non-critical equipment disinfected between patients at the point of care, e.g., a stethoscope.