Cleaning Guidelines for Care Homes. Includes cleaning standards for the general environment and equipment

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1 Cleaning Guidelines for Care Homes Includes cleaning standards for the general environment and equipment

2 Contents Page 1. Background 2. Setting the Standard 3. Introduction to Cleaning 4. Cleaning 5. Disinfection 6. Sterilisation 7. Personal Protective Equipment (PPE) 8. Hand Hygiene 9. Single use and Single Patient Use Items 10. Colour Coding 11. Risk Categories for Decontamination 12. Cleaning Processes 13. Manual Cleaning 14. Decontamination of Care Equipment 15. What Cleaning Product to use to clean and when 16. Management of Spillages of Blood and Body Fluids 17. Management of Spillages on Soft Furnishings and Carpet 18. Linen and Laundry

3 1) Background The Health and Social Care Act (2008) Code of Practice states that health and social care providers must provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections. In addition, all health and social care providers registered with the Care Quality Commission must meet a range of government regulations, including one on cleanliness and infection control Outcome 8: (Regulation 12) Cleanliness and Infection Control. Having effective infection prevention and control and cleanliness measures in place contributes to the quality and safety service users, care workers and visitors. It is essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention and control of infection must be part of everyday practice and be applied consistently by everyone (H&S care Act 2008). The National Patient Safety Agency National Specifications for Cleanliness: Guidance on setting and measuring performance outcomes in care homes (2010) document is designed to assist providers in ensuring their cleaning services address and minimise infection control risks. The document also provides guidance on meeting the required standards and promotes best practice in relation to the cleanliness of care home premises. 2) Setting the Standard The National Specifications for Cleanliness guidance for care home (2010) document provides a good foundation for care home managers and owners to refer to and adopt. It is however acknowledged that you may well have a robust cleaning plan in place and perhaps you have already referred to the National Specifications for Cleanliness for care homes as a resource.

4 By following the guidance, it will allow you as a Care Home Manger and your cleaning / domestic team to: Set the standard of cleanliness to be achieved Identify who has overall charge of cleaning (usually the Care Home Manager) Produce a robust cleaning schedule Formulate a cleaning schedule which must have a clear breakdown of the allocation of responsibilities for cleaning all areas within the home (resident s/ patient rooms, communal areas, toilets, bathrooms etc). Clearly identify who s responsibility it is for cleaning these areas and the cleaning and for regularly used residential equipment items such as wheelchair, commodes, hoists, shower chairs etc. The cleaning schedule must state the areas and frequency of cleaning activities for example daily, weekly, monthly, annually. The cleaning schedule must include clear cleaning instructions following a discharge, isolation, terminal and deep cleaning activities. Include colour coding of cleaning materials / products available for different areas Ensure routine and managerial cleaning audits take place process through which cleaning services are checked efficiency Include a timeframe for rectification of cleaning problems and resolution Include operational and training policies and procedures (ensuring all staff have received appropriate training prior to being allocated to specific cleaning tasks) Define how cleaning services operational and control dovetail with arrangement for infection control, including training for all cleaning service staff in infection control policies and procedures Record patient / resident cleaning satisfaction evaluations to promote service user and visitors confidence. The specifications are, in part and of necessity, technical in nature, but once in place should not prove onerous. The standards are designed to ensure that infection control and cleaning arrangements are co-ordinated and that patients / residents are cared for in a clean environment, where the risks of Healthcare Associated Infections (HCAIs) are kept as low as possible.

5 3) Introduction to Cleaning Micro-organisms are always present in the environment and all staff in care homes have a responsibility to ensure that inanimate objects (e.g. furniture, wheelchairs, commodes, shower chairs, re-usable medical devices etc.) in the care home environment are decontaminated properly to minimise the risk of cross infection to residents, staff and visitors. Decontamination is a general term for the destruction or removal of microbial contamination to render an item safe. Cleaning methods include: Cleaning Disinfection Sterilisation 4) Cleaning Cleaning is a process, using general-purpose detergent and hot water (<35 C), to physically remove contaminants, including dust, soil, large numbers of micro-organisms (germs) and the organic matter (e.g. faeces, blood) that protects them. Cleaning remains the single most effective way of reducing the risk of infection from the environment and is usually the first stage before disinfection or sterilisation is attempted. The value of cleaning cannot be overemphasised. Without cleaning an item first, it may not be possible to disinfect or sterilise it properly. 5) Disinfection Environmental disinfection is a process used to reduce the number of micro-organisms, but not usually of bacterial spores. The process does not necessarily kill or remove all micro-organisms, but reduces their number to a level which is not harmful. Heat disinfection methods (e.g. dishwashers, washing machines, bedpan washer s disinfectors, steam cleaners etc.) are more reliable than chemical methods and should be chosen whenever practicable.

6 6) Sterilisation Sterilisation is a process used to render an object free from all microorganisms. For care homes it is recommended that sterile equipment is obtained pre-sterilised from a manufacturer supplies and or via a Central Sterile Supplies Department (CSSD). In the care home setting when sterile or disinfected items are required sterile equipment must be single use disposable items are recommended. 7) Personal Protective Equipment (PPE) PPE must be readily available for all healthcare workers and cleaning staff - disposable gloves and aprons. Hands must be washed with soap and water after the removal of PPE Staff undertaking cleaning activities must always wear disposable plastic apron & appropriate colour coded gloves 8) Hand Hygiene It is important that cleaning / domestic staff adhere to strict hand hygiene. Important remember: Alcohol hand gel / rubs are not effective against Norovirus and Clostridium difficile spores. Soap and water must be used to enable the physical removal of spores from the hand s surface (DH 2006). 9) Single use and Single Patient Use Items Items labelled as Single-use are intended by the manufacturer to be used once and discarded. The manufacturer considers that the item is not suitable for use on more than one occasion or that there is insufficient evidence to ensure that this would be safe (MHRA 2000). Single-use items may alternatively be labelled as Do not re-use or as per international standards symbol for do not re-use, which is the figure 2 with a line drawn through it. Certain devices, e.g., nebulisers, may be used a number of times by the same service user and are described as being appropriate for single patient use. These items should be cleaned after each use following the manufacturer s instructions.

7 10) Colour Coding for Cleaning Adopting a colour coding of the cleaning of the environment and cleaning equipment is based on best practice. All cleaning items, for example, cloths (re-usable and disposable), mops, buckets, aprons and gloves, should be colour coded to reflect the different areas within the establishment. Example, of Colour Coding for different areas and cleaning (adapted from the National Patient Safety Agency) BLUE Day rooms and general areas RED Sanitary areas and body fluid spills GREEN Kitchens and food preparation (Kitchen cleaning equipment should be stored separately) YELLOW Isolation Rooms 11) Risk Categories for Decontamination The choice of method of cleaning and disinfection depends on a number of factors, which include the area or equipment to be cleaned and treated, the organism involved, and the risks to staff and residents / patients. The risks to patients / residents from equipment and the environment may be classified as follows: (Adapted, from the Medical Devices Agency 2005) IMMEDIATE RISK LOW RISK Definition Examples Suitable method Definition Examples Suitable method Items in contact with body fluid (urine / faeces) or other items contaminated with particularly virulent or highly transmissible micro-organism, or items to be used on highly susceptible patients. Bedpans, shower chairs, commode pans and urinals. Cleaned and disinfection required. Items in contact with normal and intact skin. Wheelchairs, dining room chairs Clean with neutral detergent and dried.

8 12) Cleaning Processes Thorough cleaning with detergent and warm water (body temperature) will remove large numbers of micro organisms from a surface. Reusable medical devices cannot be effectively disinfected or sterilised without having first been thoroughly cleaned and dried. Cleaning will not be effective if surfaces are damaged or rusty. An automated method such as a thermal washer/disinfector is an effective cleaning method for cleaning many reusable medical devices e.g. bedpans, commode pans, urinals. Macerators are also effective, cost effective and by pass the need for cleaning. 13) Manual Cleaning Manual cleaning is an acceptable method for cleaning the environment. A risk assessment and records of agreed procedures must be in place to ensure that a consistent method is employed by all care workers. 14) Decontamination of Care Equipment Best Practice In the care home setting the decontamination processes that will be normally used are cleaning and disinfection. Most of the general equipment can be cleaned safely using warm water and general purpose detergent. Always wear protective clothing, i.e., apron and gloves It is not always necessary to use cleaning products that contains disinfectants and other antibacterial agents. Chemical disinfection using chlorine based disinfectants may be used following cleaning for example, if items have been contaminated with blood and high risk body fluids; Clostridium difficile cases and in outbreak situations. Avoid generating splash by immersing the item where possible. If splash is unavoidable wear protective eyewear. Clean the item in an area designated for cleaning. After cleaning, rinse and inspect the equipment. If the item remains soiled, repeat the cleaning process. All equipment must be clean, fit for purpose, and in a good state of repair; All equipment must be stored in an appropriate area; If there are items of equipment that are not routinely cleaned on a daily basis, there should be a written cleaning schedule and records kept of cleaning undertaken. All reusable medical devices that need to sterile at the point of use should be supplied as single use disposable items. Dispose of cleaning solution promptly in a sluice or dirty utility area. Remove protective clothing and wash hands before carrying out other duties

9 15) What Cleaning Product to Use to Clean and When? For routine day-to-day cleaning of the environment and equipment activities: Cream cleaner or a hard surface cleaner is usually suitable for cleaning baths, toilets and hand washbasins. A neutral general purpose detergent is recommended for other environmental cleaning. Detergent wipes for example, can be used for those items that cannot be immersed e.g. wheelchairs Whilst appropriate choice of cleaning products is important, an equal amount of importance is placed on the actual physical removal of micro-organisms and visible dirt / debris by wiping, scrubbing or brushing. For general terminal cleaning of the environment this can generally be achieved by using neutral general purpose detergent and warm water For known infections resulting in isolation, terminal and or deep cleaning activities: A chlorine releasing agent to a concentration of at least 1:1000ppm is generally recommended or a combined detergent and disinfectant product. Cleaning products such as, Household thick bleach; Milton; Chlor Clean; Haz Tabs; Difficile S; Milton are recognised as acceptable cleaning products for isolation, terminal and deep cleaning activities. Important All cleaning products must be accessible, prepared, stored, applied and disposed of inline with manufacturing instructions, local and health and safety COSHH regulations. A COSHH assessment is required for any cleaning material used.

10 15. 1 Disinfectants: 1. Hypochlorite / thick bleach Has a wide range of bactericidal, virucidal, sporicidal and fungicidal activity Inactivated by organic matter, particularly if used in low concentration (need to remove organic matter first) Beware can be corrosive to some metals Diluted solutions are unstable and should be freshly Prepared 2. Sporicidal (Difficle S) cleaning product Inline with best practice, HPA and DH a sporicidal agent must be used for Clostridium difficile positive patients to deactivates spores and reduce the potential risk of spread of cross infection. 3. Sodium Dichlorisocyanurate (NaDCC). May be in the form of tablets, powders or granules. (Chlor Clean for example is a combined detergent/disinfectant) Agent of choice for dealing with outbreaks or spillages of blood or blood stained body fluids HOWEVER, DO NOT USE ON URINE SPILLAGE because chlorine gas will be Released Un-dissolved tablets, powder and granules will remain stable when stored dry but unstable when in Solution See table below for appropriate uses and strengths of Solution 4. Alcohol Good bactericidal, (including tubercle bacilli), fungicidal and some virucidal activity. Alcohol is not sporicidal. Does not penetrate well into organic matter. Must only be used once areas have been physically cleaned before hand Dilution Chart Uses of hypochlorite and strengths of solution USE DILUTION OF AVAILABLE CHLORINE SOLUTION % Parts per million (ppm) Undiluted 10* 100,000* Blood and blood stained fluids 1 in ,000 Spillages Environmental Equipment disinfection 1 in ,000 * Approximate values of some brands of Thick Bleach

11 16) Management of Spillage of Blood and Body Fluids (for example, blood) Spillages of blood and high-risk body fluids must be dealt with quickly and effectively. Disposable gloves and an apron must be worn for cleaning body fluid spillage and the contaminated debris treated as clinical waste. Chlorine-releasing agents can be a hazard especially if used in large volumes, in confined spaces or mixed with other chemicals or urine. Protective clothing must be worn and the area must be well ventilated. Sodium dichloroisocyanurate (NaDCC) method using sanitising powder or granules (do not use on carpets and soft furnishings) Wearing protective clothing, cover spillage with NaDCC granules Leave for at least two minutes. Scoop up the debris with paper towels and/or cardboard. Wash the area with general purpose detergent and water and dry thoroughly. Dispose of all materials as per clinical waste. Clean the bucket/bowl with fresh soapy water and dry. Discard protective clothing and wash hands. Hypochlorite (bleach) method (not carpets and soft furnishings) Wearing protective clothing, soak up excess fluid using disposable paper towels. Remove organic matter using the towels and discard as clinical waste. Clean area with general purpose detergent and water and disinfect the area for example with Milton or bleach releasing agent Clean the bucket/bowl in fresh soapy water and dry. Discard protective clothing and wash hand

12 17) Management of Spillages on Soft Furnishing and Carpet Detergent and water method Wearing protective clothing mop up organic matter with paper towels or disposable cloths. Clean surface thoroughly using a solution of general purpose detergent and water and paper towels or disposable cloths. Rinse the surface and dry thoroughly. Dispose of materials as clinical waste. Clean the bucket/bowl in fresh warm, soapy water and dry. Steam clean Discard protective clothing and wash hands. Spillage of body fluids urine / faeces / vomit Wearing protective clothing mop up organic matter with paper towels or disposable cloths. Clean surface thoroughly using a solution of general purposes detergent and water and paper towel or disposable cloths. Rinse the surface and dry thoroughly. During outbreaks of viral gastroenteritis disinfect surfaces for example, Milton to or a bleach releasing agent Dispose of materials Clean the bucket / bowl in fresh hot, soapy water and dry. Steam clean the area Discard protective clothing and wash hands.

13 18. Linen and Laundry Management The provision of clean linen is a fundamental requirement of care. Incorrect handling of linen may pose an infection risk to care and laundry workers. Laundry Design A designated laundry area used only for that purpose, with separate ventilation and as far away as possible from anywhere food is prepared. The design of the laundry must facilitate the creation of dirty and clean areas for example, dirty linen can be bought into one area moved through the laundry as it is processed and come out as clean laundry without crossing over the route for used laundry. Different receptacles for clean and dirty laundry should be provided, and there should be separate areas within the laundry area to ensure no contact between clean and dirty linen. Colour coded red soluble bags must be used for the segregation of fouled / infected linen / laundry. Any laundry bins should be fully washable and be well maintained. Hand washing facilities must be made available (wall mounted liquid soap / paper towels). Plastic aprons and disposable gloves should be worn for handling dirty linen. Segregation of linen / laundry Soiled linen should be placed into the appropriate colour of laundry bag. Care homes should introduce a colour coding system for the safe handling of soiled and fouled linen. Care workers must assess the condition of used linen and clothing to decide which category it falls into. Linen may be contaminated with bodily fluids and debris and may pose a risk to those who handle it. All linen (bedding and clothing) should be removed with care, avoiding the creation of dust and dissemination of skin scales, and placed in the appropriate bag at the point of use. Foul/infected linen should not be handled any more than is absolutely necessary. Used linen and fouled/infected linen should not be laundered together.

14 Do not soak or sluice by hand as this may result in cross contamination on to surfaces, uniforms and clothing of care workers. Heavily soiled linen should be prewashed at low temperature. Kitchen items and mop heads must be washed on a separate cycle. The laundry area must use separate cleaning equipment. Prevent contamination of clean linen. The designated storage area should be separated from areas used for the storage of clean linen, food preparation areas, and those parts of the home frequented by service users and their guests. Washing Machines These should be industrial washing machines with a sluice cycle and wash cycle temperatures that comply with current disinfection standards. All machines should be installed professionally with a cover over the drain to prevent aerosol contamination. An industrial dryer is recommended to ensure thorough drying of linen. Ironing will provide the final process of decontamination. Drying facilities Tumble driers are recommended

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