Protocols for Environmental Cleaning in Healthcare Facilities During COVID - 19

Practices for Environmental Cleaning in Healthcare Facilities

Environmental cleaning is part of Standard Precautions, which should be applied to all patients in all healthcare facilities.

Ensure that cleaning and disinfection procedures are followed consistently and correctly. Cleaning environmental surfaces with water and detergent and applying commonly used hospital disinfectants (such as sodium hypochlorite) is an effective and sufficient procedure.

Cleaning agents and disinfectants:

• 1% Sodium Hypochlorite can be used as a disinfectant for cleaning and disinfection.
• The solution should be prepared fresh.
• Leaving the solution for a contact time of at least 10 minutes is recommended.
• Alcohol (e.g. isopropyl 70% or ethyl alcohol 70%) can be used to wipe down surfaces where the use of bleach is not suitable, e.g. metals.

Environment surface cleaning at trauma emergency (includes Beds/ Bed Mattress /Patient Trolly/ I.V Poles/ Medicine Trolly/ Ventilator Surfaces/  Humidifiers/ Monitors/ Tubing Surfaces:

Environment surface cleaning at Corona Ward (includes Beds/ Bed Mattress /Patient Trolly/ I.V Poles/ Medicine Trolly/ Ventilator Surfaces/  Humidifiers/ Monitors/ Tubing Surfaces:

Personal Protective Equipment (PPE) to wear while carrying out cleaning and disinfection works:

• Wear heavy duty/disposable gloves, disposable long-sleeved gowns, eye goggles or a face shield, and a medical mask (please see the PPE document for details).
• Avoid touching the nose and mouth (goggles may help as they will prevent hands from touching eyes).
• Disposable gloves should be removed and discarded if they become soiled or damaged, and a new pair worn.
• All other disposable PPE should be removed and discarded after cleaning activities are completed. Eye goggles, if used, should be disinfected after each use, according to the manufacturer’s instructions.
• Hands should be washed with soap and water/alcohol-based hand rub immediately after each piece of PPE is removed, following completion of cleaning.

Cleaning guidelines:

• Where possible, seal off areas where the confirmed case has visited, before carrying out cleaning and disinfection of the contaminated environmental surfaces. This is to prevent unsuspecting persons from being exposed to those surfaces.
• When cleaning areas where a confirmed case has been, cleaning staff should be attired in suitable PPE. Disposable gloves should be removed and discarded if they become soiled or damaged, and a new pair worn. All other disposable PPE should be removed and discarded, after cleaning activities are completed. Goggles, if used, should be disinfected after each use, according to manufacturer’s instructions. Hands should be washed with soap and water immediately after the PPE is removed.
• Mop floor with routinely available disinfectant.
• Wipe all frequently touched areas (e.g. lift buttons, hand rails, doorknobs, arm rests, tables, air/ light controls, keyboards, switches, etc.) and toilet surfaces with chemical disinfectants and allow to air dry. 1% sodium hypochlorite solution can be used. Alcohol can be used for surfaces, where the use of bleach is not suitable.
• Clean toilets, including the toilet bowl and accessible surfaces in the toilet with disinfectant or 1% sodium hypochlorite solution.
• Wipe down all accessible surfaces of walls as well as blinds with disinfectant or bleach solution.
• Remove curtains/ fabrics/ quilts for washing, preferably using the hot water cycle. For hot-water laundry cycles, wash with detergent or disinfectant in water at 70ºC for at least 25 minutes.
• Discard cleaning items made of cloth and absorbent materials, e.g. mop head and wiping cloths, into biohazard bags after cleaning and disinfecting each area. Wear a new pair of gloves and fasten the double-bagged biohazard bag with a cable tie.
• Disinfect buckets by soaking in disinfectant or bleach solution, or rinse in hot water before filling.
• Disinfectant or 1% sodium hypochlorite solution should be applied to surfaces using a damp cloth. They should not be applied to surfaces using a spray pack, as coverage is uncertain and spraying may promote the production of aerosols. The creation of aerosols caused by splashing liquid during cleaning should be avoided. A steady sweeping motion should be used when cleaning either floors or horizontal surfaces, to prevent the creation of aerosols or splashing. Cleaning methods that might aerosolize infectious material, such as the use of compressed air, must not be used.
• Biohazard bags should be properly disposed-off, upon completion of the disinfection work.

 Frequency of cleaning of surfaces:

• High touch surfaces: Disinfection of high touch surfaces like (doorknobs, telephone, call bells, bedrails, stair rails, light switches, wall areas around the toilet) should be done every 3-4 hours.
• Low-touch surfaces: For Low-touch surfaces (walls, mirrors, etc.) mopping should be done at least once daily.

Precautions to take after completing the clean-up and disinfection:

• Staff should wash their hands with soap and water immediately after removing the PPE, and when cleaning and disinfection work is completed.
• Discard all used PPE in a double-bagged biohazard bag, which should then be securely sealed and labelled.
• The staff should be aware of the symptoms, and should report to their occupational health service if they develop symptoms.

Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi

MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

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