‘The essence of good cleaning is that things not only look clean afterwards, but that they are clean.’ [NPSA, 2009]
At all times ‘the hospital environment must be visibly clean; free from non-essential items and equipment, dust and dirt; and acceptable to patients, visitors and staff.’ [Loveday, 2014]
As the COVID-19 pandemic continues, the role of those responsible for cleaning in hospitals has never been more important.
To carry out this vital work, an understanding of cleaning in hospitals is essential and schülke has developed a free, online CPD accredited training module. Called ‘Introduction to surface cleaning in hospital settings’ the course summarises the importance of maintaining a clean hospital environment, offers practical advice about cleaning and includes the latest infection prevention guidance from the Department of Health for hospitals relating to COVID-19.
The easy-to-follow course is accompanied by a multiple choice test to assess the trainee’s understanding of the content. When the module test is completed the trainee will have access to a personalised certificate. Managers can monitor the progress of trainees undertaking the course.
This article is based on some sections of the training module.
How contamination can spread
Before looking at the actual cleaning process, it’s worth considering how contamination can spread in hospitals.
An infected patient can contaminate surfaces and equipment such as floors, walls, bedrails and mattresses, through coughing, sneezing and touching. Microorganisms from these contaminated surfaces and equipment can be transferred to another patient:
Hand hygiene and environmental cleaning can break the chain of transmission, this is why it is so important.
What is cleaning?
‘Cleaning’ describes the physical removal of contamination, soil, dirt or dust from surfaces, but cleaning alone is not sufficient to minimise infection risks. Cleaning is an essential step before disinfection takes place, because disinfection only works on clean surfaces.
In hospitals, cleaning is usually carried out by using dry dusting, wet wiping (pre- saturated wipes or cloths with additional liquids) or mops depending on the type of surface. Removing traces of soil by cleaning, prepares surfaces for disinfection. Germs and bacteria can live in soil which makes disinfection less effective, if the soil has not been removed.
The cleaning process includes the use of a suitable detergent to remove dirt. It breaks up grease and dirt and improves the ability of water to remove soiling, but it doesn’t necessarily eliminate bacteria, viruses, and fungi.
Is disinfection different to cleaning?
Surface cleaning is a two stage process:
Stage 1 = cleaning to remove soiling and some microorganisms
Stage 2 = disinfection to kill or inactivate microorganisms
Disinfection only works on a clean surface. Cleaning which includes the use of a suitable detergent must always happen before surface disinfection, especially on surfaces which look dirty.
Some detergents may also be disinfectants. The detergent has a cleaning effect, while the disinfectant eliminates or inactivates the microorganisms on the surface.
When using these products, the first wipe prepares a surface for the disinfection stage. Cleaning physically removes contamination, including some microorganisms and soiling if present. It is a vital step before disinfection, but does not necessarily destroy all microorganisms, even if a surface looks clean.
The second wipe aims to reduce the number of microorganisms to a level that is unlikely to cause infection.
Selecting detergents and disinfectants
Cleaning products such as disinfectants and detergents do not have to be colour coded, unlike items such as mops and buckets.
Only detergent and disinfectant products supplied by the Trust should be used. Products must be prepared and used according to the manufacturers’ instructions. [DoH, 27/3] Recommended product “contact times” must be followed. The contact time is the amount of time needed for the disinfectant to be effective at inactivating microorganisms.
If alternative cleaning agents/disinfectants are to be used, this should only be with advice from the Infection Prevention and Control Team and must conform to EN standard 14476 for virucidal activity [DoH, 2020]
What is enhanced cleaning?
‘There is evidence from other coronaviruses of the potential for widespread contamination of patient rooms or environments, so effective cleaning and decontamination is vital.’ [DoH, 2020]
Enhanced cleaning is when additional cleaning methods are used as well as the standard ones. This may include cleaning some surfaces more frequently or using extra cleaning equipment. Enhanced cleaning may be applied to all areas of the hospital or in specific circumstances, such as cleaning of rooms or bed spaces following the transfer or discharge of patients who are infected with for example COVID-19. This is also called ‘terminal cleaning’.
Accessing the course
The ‘Introduction to surface cleaning in hospital settings’ course can be accessed at work or at home on a variety of smart devices and offers 1 hour and 30 minutes of verifiable CPD. The course can be undertaken as a series of short modules.
Please use this link to find out more: https://www.schuelke-learning.com/course/introduction-to-surface-cleaning-in-hospital-settings
Loveday HP et al, Epic 3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England, Journal of Hospital Infection 86S1 (2014) S1–S70
The National Patient Safety Agency (NPSA) Revised Cleaning – The Revised Healthcare Cleaning Manual, 2009
Public Health England, Reducing the risk of transmission of COVID-19 in the hospital setting, 5th April 2020, https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control/reducing-the-risk-of-transmission-of-covid-19-in-the-hospital-setting#environmental-decontamination accessed 20th January 2021