Infection prevention and control guidelines

9. Cleaning, laundry and waste management

Scheduled cleaning

      1. Scheduled cleaning

Scheduled cleaning

Practices must have a cleaning schedule that ensures that the practice is systematically and appropriately cleaned. The cleaning schedule sets out the staff who are responsible for cleaning, the surfaces that need cleaning, the frequency of cleaning, the cleaning method, and the products and equipment to be used (Table 9.2. Examples of items in a practice cleaning schedule).

In addition to scheduled cleaning (routine cleaning that occurs at pre-planned intervals, regardless of events), opportunistic cleaning may also be necessary throughout the working day. This may include cleaning surfaces after they are touched by a patient with a potentially transmissible infection (for example, disinfecting a chair or examination table after a patient with influenza).

The cleaning agent, method and frequency depend on the risk of transmission of clinically significant pathogenic microorganisms. The practice’s risk assessment for each surface or item will depend on:

  • the potential for exposure (eg high-touch versus low-touch surfaces)
  • the pathogenic microorganisms likely to be present, including the possible presence of multidrug-resistant microorganisms (Table 9.3. Examples of persistence of microorganisms on dry surfaces). This may change over time, eg during an outbreak
  • and the vulnerability of patients or staff to infection.

Table 9.2. Examples of items in a practice cleaning schedule  Download the spills cleaning protocols template

Surface

Usual cleaning agent(a)

Usual method(b)

Frequency

Person responsible

Door handles (consultation rooms, examination room)

Detergent and water

Damp wipe

Daily

[Name]

Door handles (toilets)

Detergent and water

Wipe

Twice daily and after use by patient with suspected relevant infection

[Name]

Surfaces (bench tops, couches, sinks, toilets, sanitary bin lids, floors)

Frequently touched surfaces (light switches, handrub dispensing pumps)

Detergent and water

Damp wipe with a disposable cloth or wipe

As determined by the practice, eg:

Bench tops, sinks, toilets and treatment room floors daily

Other floors every second day

Frequently touched surfaces twice daily during an outbreak

[Name]

Hard floors

Detergent and water

(Detergent and disinfectant if required for a specific organism)(c)

Vacuum (using vacuum cleaner with HEPA-filter) then damp-mop to ensure dust is captured and not dispersed into the air.

Spot cleaning with detergent and paper towel

(Note: mops must be cleaned and left to dry after use, not left wet in a bucket.)

As determined by the practice

[Name]

Carpet(d) – regular vacuum cleaning

Vacuum cleaner with high-efficiency particulate absorbing filter

Vacuum

As determined by the practice (eg daily)

[Name]

Carpet(d)/carpet tiles – spot cleaning

Carpet cleaning solution recommended by manufacturer

or

Vacuum cleaner

Replace carpet tiles that are marked or contaminated

Use spill kit to blot excess moisture and other matter (eg vomitus)

Clean according to directions for use

Dry carpet quickly (ventilation/heating) and quarantine room until dry

Use carpet cleaning solution for other spills

Use vacuum cleaner for solid objects

As determined by the practice (eg when soiled)

[Name]

Carpet – steam(e)/dry cleaning

Usually performed by a carpet cleaning contractor using a hot water extraction method recognised by the current relevant standard to minimise chemical and soil residue

Perform out of hours if possible

Dry carpet quickly (ventilation/heating) and quarantine area until dry

As determined by the practice (eg when soiled or yearly)

[Name]

Fabrics (eg upholstered furniture)(f)

Fabric cleaner recommended by the manufacturer

or

Detergent and water

Clean according to directions for use and quarantine the item until dry

As determined by the practice (eg when soiled)

[Name]

Drug refrigerator (outside surface and handle grooves)

Detergent and water or disinfectant

Wipe

Daily spot check

Weekly clean

[Name]

Other items (eg stethoscopes,(g) plastic blood pressure cuffs, pulse oximeters, digital thermometers, tape measures, digital devices)

Detergent and water, detergent wipes

Clean thoroughly, wipe over with detergent wipe

As determined by the practice

[Name]

Mobile phones, tablets

Detergent and water, detergent wipes, alcohol wipes

Wipe

Frequently

[Name]

Computer keyboard(h)

Detergent and water, detergent wipes, alcohol wipes Wipes should be moist but not dripping, to avoid damage to keyboard.

Wipe

Twice daily and when visibly soiled

[Name]

HEPA: high-efficiency particulate absorbing

a. The choice to use a disinfectant depends on the local epidemiology and a local risk assessment, such as the presence of a multi-drug resistant organism or other pathogen of concern.

b. Does not apply to blood and body substance spills management

c. The use of a TGA-listed hospital-grade disinfectants with specific claims for efficacy against relevant microorganisms, or a chlorine-based product such as sodium hypochlorite, should be based on assessment of the risk of transmission of infectious agents from the particular spill and the compatibility of the disinfectant with the floor material where the spill occurred.

d. Carpet should not be installed in treatment areas, which should have hard smooth flooring that can be easily cleaned.

e. Steam cleaner must operate at correct temperature to inactivate microorganisms.

f. Upholstered chairs should be avoided and replaced with chairs that have non-porous, smooth surfaces and smooth edges with no grooves or crevices.

g. Some products can damage stethoscope tubing. Check the manufacturer’s advice. stethoscope tubing

h. Washable keyboard covers may be installed.
 

Table 9.3. Examples of persistence of microorganisms on dry surfaces

Microorganism

Persistence (days)

Acinetobacter species

3 days to 5 months

Clostridium difficile (spores)

5 months

Enterococcus species

5 days to 4 months

Escherichia coli

1.5 hours to 16 months

Klebsiella species

2 hours to >30 months

Mycobacterium tuberculosis

1 day to 4 months

Pseudomonas aeruginosa

6 hours to 16 months

Salmonella typhimurium

10 days to 4.2 years

Shigella species

2 days to 5 months

Staphylococcus aureus

7 days to 7 months

Haemophilus influenza

12 days

Adenovirus

7 days to 3 months

Human coronaviruses*

Up to 9 days

Influenza virus

1–2 days

Norovirus

8 hours to 7 days

Reported time ranges for microorganisms detected on dry surfaces (range of surface types as investigated in studies).

*human coronaviruses such as severe acute respiratory syndrome (SARS) coronavirus, Middle East respiratory syndrome (MERS) coronavirus or endemic human coronaviruses

Sources: Siani et al (2015),2 Kampf (2020)3

Scheduled cleaning duties

The cleaning schedule must identify the staff who have responsibility for cleaning and their specific duties. These staff members need task-specific education and training.

If cleaning activities are outsourced to cleaning service providers, practices should make sure that contract cleaners clearly understand their role in the practice’s infection prevention and control, including when, how and why they need to clean specific surfaces and equipment. Document all cleaning delivery procedures, including minimum cleaning frequencies and methods, staffing, equipment (including chemicals for standard and transmission-based precautions, monitoring/auditing, and management of the cleaning service).

Scheduled cleaning of surfaces

All environmental surfaces within the practice must be included in the cleaning schedule to ensure that the practice is systematically cleaned. The level of cleaning must be determined based on the risks of contamination and transmission of infection. Risk assessment considers the frequency of traffic or bodily contact of each surface.

Surfaces in frequent use and likely to become soiled over a day include carpets, toilet/bathroom fixtures, consultation room furniture and equipment (examination couch, desk and medical equipment).

Surfaces with minimal contact include windows, walls, doors and general furniture.

It is unfeasible to clean some frequently touched items (eg pens, handles, phones, keypads, computer keyboard, mouse) after each use. These items may be considered as always contaminated; after touching any of these items, health professionals must clean their hands before patient contact (see Hand hygiene).

A practice’s risk assessment should determine if and when frequently touched items should be cleaned.

Frequency of scheduled cleaning

The cleaning schedule must allow for more frequent cleaning of surfaces that are subject to frequent contact (eg heavily trafficked or high-use areas).

Clean frequently touched surfaces at least daily. During an outbreak, cleaning may be necessary twice daily or more often, as advised by health authorities.

In addition to scheduled cleaning, clean high-use surfaces whenever they are visibly soiled and after every known contamination by a likely pathogen.

Surfaces that are subject to less frequent contact can be scheduled for less frequent cleaning, as well as being cleaned when visibly soiled or immediately after contact with blood or other body substances.

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