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Transcript of Office of Epidemiology and Prevention Services DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY ...
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Environmental Cleaning
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Objectives
• Understand types of cleaners most commonly used in long term care facilities
• Understand how to write a policy and procedure for environmental cleaning in a patient room
• Understand how to monitor environmental cleaning
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Environmental Cleaning and Its Relevance to Infection Prevention & Control
• Primary focus must remain on protection of client/resident, staff and visitors
• Practices must help minimize spread of infection• Practices are understandable and attainable• Practices must incorporate workflow measurement• Practices must be reviewed regularly to keep them
current
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
How Long Can Germs Live???
• Entercocci and staphylococci on hospital fabrics and plastics up to 90 days
• MRSA outbreak strains-up to 9 weeks after drying• Gram-negative bacteria (pseudomonas aeruginosa,
salmonella, E.coli etc)-on hospital fabrics and plastics up to 60 days
• VRE-58 days on countertops• Influenza-48 hours on nonporous surfaces
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Principles of Effective Cleaning
• Apply to all settings where care is delivered– Process – Selection of appropriate product for the task– Frequency
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Environmental Cleaning PrinciplesHighest point and work towards the lowest
From the outside to the inside
From the cleanest to the dirtiest
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Environmental Cleaning Principles
• Cleaning in a determined pattern will ensure that all surfaces are being cleaned
• You will know where you left off if you are interrupted during cleaning
CLEAN IN AN ESTABLISHED PATTERN
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Choosing a Disinfectant
• Type of microorganism, number and presence of spores• Physical situation (e.g., surface type)• Contact available between disinfectant and microorganisms• Possible interaction between disinfectant and materials• Contact time allowable• Concentration• EPA registered
Microorganisms present a range of resistances to chemical disinfectants and no single disinfectant is effective in all situations.
Consider the following points when selecting a disinfectant:
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Choosing a Disinfectant
• “Hospital disinfectant” effectiveness– Pseudomonas aeruginosa– Staphylococcus aureus– Salmonella choleraesuis
• “Tuberculocidal” indicator of effectiveness– Broad spectrum
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Types of Disinfectants
• Chlorine compounds– Generally used in the form of sodium hypochlorite
• Alcohols– Ethanol (80% v/v ethyl alcohol) or 2-propanol (60-70% v/v
isopropyl alcohol) solutions are used to disinfect skin and decontaminate clean surfaces
• Hydrogen Peroxide– A concentration of 3% (weight/volume) generally used for
disinfection
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Types of Disinfectants
• Phenolics– Synthetic phenolics (clear soluble fluids) can be used as
general disinfectants in the laboratory
• Quaternary Ammonium Compounds– Quaternary ammonium compounds are positively charged
surface active disinfectants
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Advantages and Disadvantages of Common Disinfectants
Disinfectant Advantages Disadvantages
Sodium hypochlorite(household bleach)
InexpensiveFast-actingWidely availableActive against bacteria, spores, Mtb, viruses
Odor can be irritatingCorrosive to metalsInactivated by organic materialMay discolor fabrics
Ethyl or isopropyl alcohol (70-90%)
InexpensiveWidely availableRapidly effectiveActive against bacteria, Mtb, viruses
Not effective against bacterial sporesNot for large surfaces
Rutala WA et al. CDC Guideline for Disinfection & Sterilization In Healthcare Facilities, 2008
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Advantages and Disadvantages of Common Disinfectants
Disinfectant Advantages Disadvantages
Quaternary ammonium compounds
Not too expensiveWidely availableGood cleaning agents
Not effective against bacterial spores, Mtb, non-enveloped virusesMay become contaminated
Phenolics Widely available Use on bassinets may be toxic to infantsPoor activity against bacterial spores and non-enveloped viruses
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Using Disinfectants Wisely
• Item or surface must first be free of visible soil (unless using a combined cleaner/disinfectant)
• Use according to the manufacturer instructions:– Dilution, temperature, contact time, etc.
• No double dipping• No spraying disinfectants• Use proper PPE to prevent exposure to chemical as
on MSDS
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Frequency of Cleaning
High/low touch items
Level of contamination
Client/resident risk level
FREQUENCY OF CLEANING
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Frequency of Cleaning: High-touch Surfaces
Determine your own high-touch surfaces!
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Frequency of Cleaning
• Heavy contamination– Exposed to major amounts of blood or body fluids
(bathrooms of client/resident with diarrhea)
• Moderate contamination– Exposed to some amounts of blood or body fluids
(client/resident room or bathroom)
• Light contamination– Not exposed to blood or body fluids (offices, lounge,
library)
Level of Contamination
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Frequency of Cleaning
• More at risk persons– Chemotherapy, dialysis, burns or other major wounds,
indwelling devices, etc.– MDRO patients, CDI patients
• Less at risk persons– All others
Client/Resident Risk Group
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Determining How Often To CleanProbability of contamination with pathogens
Potential for Exposure
High touch surface =3 Low touch surface = 1
At risk persons = 1
Less at risk persons = 0
At risk persons = 1
Less at risk persons = 0
Heavy contam = 3 7 6 5 4
Moderate contam = 2 6 5 4 3
Light contam = 1 5 4 3 2
= cleaning once a day and when soiled.
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Applying the Scores
Total Cleaning Score
Risk Type Minimum Cleaning Frequency
7 High Risk Clean after each case/event/procedure and at least 2x per day and when soiled
4-6 Moderate risk Clean at least once a day and when soiled
2-3 Low risk Clean on a regular schedule < 1x per day and when soiled
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Documenting Cleaning Policies• Plan components– Defined responsibilities for items and areas– Procedures for various cleaning tasks– Procedures for specific organisms that transmit well in the
environment– Procedures for outbreaks– Cleaning standards including how often to clean– Monitoring process– Education
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Is It Really Clean?
• Not just a visible check!• Must include audits of actual work• May use “markers” e.g. glo germ solution to
check for “missed” spots• Cultures are not generally recommended
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Exercises
DISCLAIMER: The product insert(s) used for the exercises in no way imply endorsement or recommendations of these products by the West Virginia Department of Health and Human Resources. They are used for educational purposes only.
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Reading a Product Insert
• Which category of cleaner is this product?• What are the ingredients and concentrations?• What organisms is this effective against?• What is the contact time?• How should the product be applied?• Is any PPE needed to use the product?• Are there special instructions for specific
organisms?
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Group Exercise – Writing a Cleaning Plan for Long Term Care• Scenario: – 86 year old with VRE infection of the urine.– Limited mobility; uses bedside commode and
community showers– Incontinent of urine and stool usually contained
with adult briefs– Has to be reminded to wash hands
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Writing a Cleaning Plan
• Materials:– Exercise Worksheet (in notebook)– One copy for each table:• Pictures of patient room• Product Inserts
• Using the exercise sheet and the materials provided, write a cleaning plan
• Be prepared to discuss your plan
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Discussion
• Bed rails, call light, TV remote– Product:– How to use:– Contact time:– How frequently?– Who?– (why?)
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Discussion
• Sink and fixtures:– Product: – How to use:– Contact time:– How frequently?– Who?– (why?)
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Discussion
• Bedside commode:– Product:– How to use:– Contact time:– How frequently?– Who?– (why?)
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Discussion
• Bathroom:– Product:– How to use:– Contact time:– How frequently?– Who?– (why?)
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
Acknowledgments and References
• Ontario Public Health Agency of Canada• CDC Environmental Guidelines for Health
Care Facilities• APIC Guide to Elimination of MRSA in the
Long Term Care Facility
Office of Epidemiology and Prevention ServicesDIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGYwww.dide.wv.gov
QUESTIONS?
THANK YOU!