Principles for cleaning and disinfecting the non-critical hospital environment using instrument disinfectants
Surface cleaning is an important strategy for reducing the transmission of pathogenic organisms and preventing healthcare-associated infections in healthcare facilities. The role of sanitization is to reduce the number of infectious agents that may be present on surfaces and to minimize the risk of transferring microorganisms from one person/object to another, thereby reducing the risk of infection.
Furthermore, surface disinfection is a key component of standard precautions; it is the first line of infection prevention and control in the healthcare environment, and the use of instrument disinfectants is essential. These work practices are recommended for the treatment and care of all patients. The importance of environmental cleaning and decontamination is increased when these processes are used as part of transmission-based precautions and infection outbreak management.
Table of Contents
- Key principles for the surface cleaning process in healthcare facilities
- Use of disinfectants
- Choosing a disinfectant
- Cleaning and disinfection methods
- Cleaning and disinfection products and equipment
In recent years, there has been a general consensus regarding the need to improve cleaning, sanitization, and surface disinfection procedures in hospitals and medical clinics. The use of surface disinfectants and instrument disinfectants is mandatory, but attention must also be paid to choosing suitable and effective products, as well as their proper use.
Some experts favor the physical removal of microorganisms using only a detergent solution and a degreaser. Other specialists believe that manual surface disinfection using currently available disinfectants is adequate and that newer approaches to disinfection are not necessary. (Source)
Moreover, cleaning procedures should be considered an essential part of a comprehensive hospital infection prevention program, with protocols in place to support good performance; this should include strategies for optimizing product use, technique, audit and feedback, cleaning staff education, and communication. National safety and health service quality standards require healthcare service institutions to have processes in place to maintain a clean and hygienic environment.
1. Key principles for the surface cleaning process in healthcare facilities
Use of detergent
A detergent is a surfactant that facilitates the removal of dirt and organic matter, including from floors.
Most hard surfaces can be cleaned adequately with warm water and a neutral detergent, according to the manufacturer's instructions. Surfaces must be dry before applying another product, such as surface disinfectants.
Physical cleaning with detergent and water is recommended for routine cleaning.
Routine cleaning of floors with detergent and water is recommended. Freshly cleaned floor areas can be quickly recontaminated by shoes, equipment wheels, dust, etc., and microorganisms on floors pose a minimal risk to patients. A suitable solution should be used, such as detergent and degreaser for floors, rather than an all-purpose product.
2. Use of disinfectants
A disinfectant is a chemical agent that rapidly kills or inactivates most infectious agents. Surface disinfectants should not be used as general cleaning agents unless they are combined with a detergent as a combined cleaning agent (detergent-disinfectant), along with instrument disinfectants.
Disinfection must always be performed after and in addition to cleaning with detergent and degreaser.
The use of a disinfectant is necessary:
- 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-risk or extreme-risk environments (in accordance with local risk assessment)
- for terminal cleaning after the care of a patient with multi-resistant organisms or other infectious diseases.
- For sanitizing utensils, in which case the use of instrument disinfectant solutions is required.
Routine use of a disinfectant in other areas of a healthcare facility or for cleaning all discharges must be determined locally by the infection prevention and control team, after conducting a risk assessment that takes into account the local epidemiology of the disease.
3. 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 cost-effectiveness must be considered.
Klintensiv Tip: We recommend using only professional medical disinfectants, as these products are the only ones that guarantee the elimination of pathogens.
Among the new disinfectants currently available or under development are liquid disinfectants enhanced with hydrogen peroxide, combinations of peracetic acid and hydrogen peroxide, electrolyzed water, cold atmospheric pressure plasma, and polymeric guanidine. Several enhanced hydrogen peroxide disinfectants have proven to be effective single-step cleaning/disinfection agents that significantly reduce bacterial levels on surfaces and floors. (Source)
Considerations on the use of disinfectants
Care must be taken to ensure that the correct chemical product is used properly and in accordance with the manufacturer's specifications.
When using instrument disinfectants, it is especially important that the contact time be correct (i.e., the time required for the disinfectant to be in contact with the surface to inactivate microorganisms).
It is also necessary to replace solutions regularly, especially when heavily contaminated areas are being sanitized; 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): (Source)
- hand hygiene
- point-of-care risk assessment
- personal protective equipment
- handling of patient care items and equipment
- handling of waste and sharps and the use of instrument disinfectants
- environmental cleaning
- use of a degreaser for visibly dirty areas.
Klintensiv Tip: Hand hygiene is the most important factor in preventing the transmission of microorganisms. This should be performed using solutions certified and approved by the Ministry of Health through the National Commission for Biocidal Products.
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 when handling dirty or potentially contaminated objects.
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 cleaning rough surfaces):
- they should be dedicated to a specific staff member;
- they should be cleaned in accordance with the manufacturer's instructions;
- ensure that the gloves are dry inside and out before being reused;
- inspect the material during use and discard 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, e.g., when cleaning large spills.
4. Cleaning and disinfection methods
Cleaning represents the physical removal of dirt and debris through mechanical action by 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 efficacy of disinfectants. For floors, a product with enhanced dirt-removal capabilities should be used.
Disinfection is the inactivation of disease-causing microorganisms by wetting a surface with a ready-to-use disinfectant wipe or a cloth saturated with disinfectant. To achieve effective disinfection, the surface must remain wet for the contact time recommended by the manufacturer.
If a disinfectant claims to have both cleaning and disinfection properties, the product can be used for both steps by following the manufacturer's instructions.
Before cleaning:
- gather the necessary cleaning supplies;
- remove unnecessary objects from the surfaces to be cleaned;
- clean reusable equipment before removing it from the patient space, possibly using a degreaser;
- collect and handle waste bags from the top;
- check sharps containers and replace them when full.
Preparing cleaning and disinfection solutions:
Distribute instrument disinfectant type solutions, hand hygiene and disinfection solutions into clean, dry, appropriately 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 the 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 to enter the cleaning or disinfection solution. Do not dip a used cloth into the cleaning or disinfection solution (double-dipping);
- begin cleaning from clean areas toward dirty areas. Bathrooms should be cleaned last; from low-frequency touch surfaces to high-frequency ones.
5. Cleaning and disinfection products and equipment
Only professional cleaning and disinfection products and equipment intended for use in an in-hospital environment shall be used. Do not use unapproved products, such as household cleaners.
Select the appropriate product for the intended task, e.g., cleaning or disinfection.
Follow the instructions for use and the manufacturer's 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 do not replace the cleaning process.
Do not mix different types of cleaning/disinfection products (unless specified by the manufacturer), as chemicals can react with each other, e.g., enhanced hydrogen peroxide products and quaternary ammonia products.
Use ready-to-use disinfectant wipes for cleaning and disinfecting patient equipment at the point of care, such as:
- Items in the care environment that do not 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., stethoscope.
Conclusion
Hygiene is a first step toward a safe environment in hospitals and medical clinics. Cleaning procedures are the first stage of the process of removing potentially dangerous pathogens. In addition to cleaning, the disinfection of surfaces and instruments is necessary, especially in critical areas and those where infectious diseases are treated, using instrument disinfectants. The use of professional solutions is always required due to their properties of removing a wide spectrum of microorganisms.
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