 Healthcare&HospitalHygiene


Cleaning to prevent contagion in healthcare settings


Gary Johns, sales director designate of In Depth Managed Services, looks at the importance of using specialised staff and equipment to comply with NHS guidelines for cleaning a dialysis centre.


Cleaning and disinfection


The essence of good cleaning is that things not only look clean, but they are clean. The first step is routine cleaning to ensure the environment is visibly clean and free from dust and soil, according to guidelines for prevention of hospital acquired infections by the World Health Organisation - Europe, published in 2002. 90% of microorganisms are present within ‘visible dirt’ and the purpose of routine cleaning is to eliminate this. There is now a national colour-coding


system in place for the NHS for hospital cleaning materials and equipment. This should be followed at all times by cleaners and is aimed at ensuring that these items are not used in multiple areas, therefore reducing the risk of cross-infection. Disposable products, including gloves,


aprons andmop heads, are recommended in isolation units. Disinfection of the environmental surface


We’re all familiar with the risks related to contagion of infectious diseases for pa- tients, hospital staff, visitors and house- keeping staff in hospitals and healthcare environments. However, in a dialysis set- ting these risks are amplified because renal patientsmay carry so-called blood borne pathogens that could lead to the in- fection of others. The patients are also at amuch higher


risk of getting healthcare-associated infec- tions because the dialysis process requires frequent use of catheters or needles to ac- cess the bloodstreamand the patients’ im- mune systems are very weak,making them more vulnerable to infection.MRSA, Hepa- titis B and HIV are the biggest worries in a dialysis setting. Microorganisms that could cause disease


are known to survive on inanimate ‘touch’ surfaces for extended periods of time, for example bedrails, over-the-bed trays, call buttons and bathroomhardware,making it essential for this type of environment to be cleaned by specialist staff who are trained to comply with NHS guidelines on cleaning in healthcare environments. The Revised Healthcare CleaningManual


(2009) is aimed at providing guidance on cleaning techniques and best practice ad- vice on defining responsibilities, scheduling work,measuring outcomes, reporting and driving improvements. The regulations are supported by the Code of Practice for the NHS on the Prevention and Control of Healthcare Associated Infections and Re- lated Guidance. Hospitals and healthcare environments, including dialysis centres, need to demonstrate that they provide and maintain a clean and appropriate environ- ment that facilitates the prevention and control of healthcare associated infections Responsible contract cleaning providers


who offer services in these types of envi- ronment, need to have an excellent knowl- edge of the regulations and train staff to comply within these guidelines, which will


24 l C&M l APRIL 2013 l www.cleaninghub.net


The Revised Healthcare Cleaning Manual (2009) is aimed at providing guidance on cleaning techniques and best practice advice on defining responsibilities, schedulingwork, measuring out- comes, reporting and driving improvements.


also formthe basis of any infection control policies drawn up by the individual clinic or hospital.


Hand hygiene


According to theWorld Health Organisation (WHO), hand washing is themost important measure to prevent contaminant transmis- sion in a healthcare environment.When to wear gloves and when to performhand hy- giene is therefore the first priority for every- one to be aware of, including cleaning operatives, who enter these areas. In the case of patients with severely com-


promised immune systems, such as renal patients, the risk of infection is very high and theWHO (Prevention of hospital-ac- quired infections - a practical guide) rec- ommends hand and forearmwashing with a good antiseptic scrub (contact 3-5min- utes), followed by drying with sterile dis- posable towels. Alternatively, surgical disinfection proce-


dures are recommended by rubbing, in- cluding simple handwash and drying followed by two applications of hand disin- fectant, then rubbing to dry for the duration of contact defined by the product. These surgical procedures are recommended for anyone touching inanimate objects in the immediate vicinity of the patient.


Uniforms and jewellery


Because hand and wrist jewellery can har- bourmicro-organisms and reduce compli- ance with hand hygiene, it is good practice to remove these at the beginning of the shift. Sleeves on uniforms should either end above the elbow or be kept rolled up above the elbow when cleaning. Staff should change into a clean uniform


before each shift and if the uniformbe- comes visibly contaminated or soiled, they should change the uniformat the earliest practical opportunity.


is the next step and almost seen as a somewhat redundant step to ensure com- prehensive removal of pathogens on sur- faces. A commonly used disinfectant for blood contaminated environmental sur- faces is a 1:100 dilution of bleach (500–600 ppm free chlorine). For each disinfectant, follow the manufacturer's instructions re- garding use, including appropriate dilution and contact time.


Waste disposal


The handling and segregation of waste must be undertaken with care. Members of staff should ensure that they are fully aware of their local waste policy and that they follow it closely. Any waste that is, or might be suspected


to be, contaminated with bodily substances should be disposed of as clinical waste. Common examples includemedical gloves, aprons, dressings, and catheter bags. Clini- cal waste bagsmust always be marked or tagged to ensure that their department of origin can be traced. Normally, plastic tags are issued for this purpose. Clinical waste containers should be


locked at all times and not accessible to the general public. Clinical waste from an in- fected source should be double bagged and disposed of in the normal way.


Experience and knowledge


Because of the specialised nature of clean- ing in dialysis environments, when out- sourcing the housekeeping or cleaning of the environment it is vital to ensure the company has experience and knowledge of the regulations, products and procedures needed to comply with infection control measures. In Depth Managed Services has worked


in dialysis centres across the UK for many years and has specialised staff and training procedures in place to reduce the risk of contagion in line with NHS and interna- tional guidelines. www.indepth-cleaning.co.uk


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