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. 

We’re all familiar with the risks related to contagion of infectious diseases for patients, hospital staff, visitors and housekeeping staff in hospitals and healthcare environments. However, in a dialysis setting these risks are amplified because renal patients may carry so-called blood borne pathogens that could lead to infection of others.

The patients, themselves, are also at a much higher risk of getting healthcare-associated infection because the dialysis process requires frequent use of catheters or needles to access the bloodstream and the patients’ immune systems are very weak, making them more vulnerable to infection.

MRSA, Hepatitis 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 bathroom hardware, 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 Cleaning Manual (2009) is aimed at providing guidance on cleaning techniques and best practice advice 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 Related Guidance. Hospitals and healthcare environments, including dialysis centres, need to demonstrate that they provide and maintain a clean and appropriate environment that facilitates the prevention and control of healthcare associated infections

Responsible contract cleaning providers who offer services in these types of environment, need to have an excellent knowledge of the regulations and train staff to comply within these guidelines, which will also form the basis of any infection control policies drawn up by the individual clinic or hospital.

Hand hygiene

According to the World Health Organisation (WHO), hand washing is the most important measure to prevent contaminant transmission in a healthcare environment. When to wear gloves and when to perform hand hygiene is therefore the first priority for everyone to be aware of, including cleaning operatives, who enter these areas.

In the case of patients with severely compromised immune systems such as renal patients, the risk of infection is very high and the WHO (Prevention of hospital-acquired infections – a practical guide) recommends hand and forearm washing with a good antiseptic scrub (contact 3-5 minutes), followed by drying with sterile disposable towels.

Alternatively, surgical disinfection procedures are recommended by rubbing, including simple handwash and drying followed by two applications of hand disinfectant, 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 harbour micro-organisms and reduce compliance 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 uniform becomes visibly contaminated or soiled, they should change the uniform at the earliest practical opportunity.

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.

Ninety percent of microorganisms are present within ‘visible dirt’ and the purpose of routine cleaning is to eliminate this dirt.

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 and mop heads, are recommended in isolation units.

Disinfection of the environmental surface is the next step and almost seen as a somewhat redundant step to ensure comprehensive removal of pathogens on surfaces.

A commonly used disinfectant for blood contaminated environmental surfaces is a 1:100 dilution of bleach (500–600 ppm free chlorine).

For each disinfectant, follow the manufacturer’s instructions regarding 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 include medical gloves, aprons, dressings, and catheter bags.

Clinical waste bags must 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 infected source should be double bagged and disposed of in the normal way.

Experience and knowledge

Because of the specialised nature of cleaning in dialysis environments, when outsourcing 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 have worked in dialysis centres across the UK for many years and have specialised staff and training procedures in place to reduce the risk of contagion in line with NHS and international guidelines.

http://www.indepth-cleaning.co.uk

Published in Cleaning & Maintenance – April 2013