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Infection Prevention, and Control Guidelines for Primary Care Physicians

• Back to Table of Contents
  
  

Environmental Cleaning

• Selection Criteria for Low Level Disinfection

The Family Health Team practice environment contains a variety of microorganisms, only a few are significant pathogens to humans. Microorganisms are present in great numbers in moist, organic environments, but some also can persist under dry conditions.  Accumulation of dust and soil on environmental surfaces increases potential reservoirs of microorganisms. Trends in health-care delivery (e.g. early discharge of patients from acute care facilities) are changing the distribution of patient populations and increasing the number of immunocompromised persons receiving care in the community setting. Effective cleaning methods and schedules are necessary to maintain clean and healthy environments.

Best Practices:

Cleaning Principles:

• Careful mechanical cleaning of surfaces is the most effective way to remove many contaminants. This is especially important when there are obviously soiled areas, as the gross matter needs to be removed before the disinfectant is applied.
  
  
• High touch surfaces need to be cleaned and disinfected because of the great amount of handling increasing the risk of cross-transmission of infection (e.g. door knobs, handles, blood pressure cuffs, light switches, telephones, and bathroom fixtures). Frequently touched surfaces should be cleaned once a day, and when visibly soiled. Items that require less frequent cleaning because they are handled less often and are not apt to be sources of infection (e.g. walls).
  
  
• Clean from the highest point to the lowest, and outside to the inside; basically the cleanest to dirtiest, this reduces the potential of moving and spreading microorganisms around.
  
  
• Never shake a dust cloth or mop in order to prevent the inhalation of dust and potential pathogens by staff or patients. Use a damp cloth or mop.
  
  
• Disinfectant contact time is the amount of time the item needs to remain wet so that the disinfectant can destroy the pathogens. It is important to allow the disinfectant to air dry, do not wipe disinfectant off with towel, or promote drying with a fan.

Cleaning Schedules:

• Examination Rooms:
  

• After each patient:
  
  
• Linen or paper and pillows on the table should be changed
  
  
• Contaminated horizontal surfaces are cleaned with a disinfectant
  
  
• Uncovered examination tables should be cleaned between patients
  
  
• End of the day:
  
  
• Horizontal surfaces and floors should be thoroughly cleaned with  a disinfectant
  
  
• Waste containers emptied.
  
  
• Offices and Meeting Rooms:
  
  
• As needed when soiled
  
  
• Daily (e.g. waste containers emptied)
  
  
• Weekly (e.g. dusting, horizontal surfaces (tables, chairs) floors)
  
  

• Frequently touched toys should be cleaned daily (do not use Phenol based disinfectant). If not cleaned daily, remove toys from setting.
  
  
• Allow to air dry
  
  
• If toys are visibly soiled, wash with warm soap and water then disinfect
  
  
• Do not have cloth or plush toys as they can not be cleaned or disinfected properly

Computers:

• When cleaning or disinfecting computer hardware follow manufactures recommendations. If possible use the same cleaner or disinfectant that is used for general office cleaning.

• The keyboard and mouse should be included in the routine cleaning protocol
  
  
• Consider the use of plastic covers on hardware (e.g. keyboards, monitors, keypads, and others) or the use of submersible keyboards as they are easier to keep clean
  
  
• All computer hardware should have as many smooth surfaces as possible to reduce the risk of microbial contamination.

Flooring and Carpets:

• Floors should be kept clean with a disinfectant-detergent solution on a regular basis and when obviously soiled
  

• Carpets should be kept in good condition

• Regular vacuuming and deep cleaning is recommended
  
  
• Vacuums should be in proper working order to minimize dust and fungal spore dispersal
  
  
• Carpets should be scrubbed regularly. After a deep cleaning, the carpet should dry within 72 hours to minimize the growth of fungi.
  
  
• Carpets are not recommended in high traffic areas or procedure rooms

• Put on a pair of disposable gloves

• Remove  as much visible soil as possible using paper towels
  
  
• Clean the area with detergent and water
  
  
• Disinfect the area with a fresh solution of 1:10 bleach (50ml of bleach to 450ml of water) or facility approved disinfectant
  
  
• Leave the bleach solution in contact with the surface until dry
  
  
• Dispose of soiled paper towel in garbage, remove gloves and wash hands.

References:

Canadian Committee on Antibiotic Resistance (2007) Infection Prevention and Control Best Practices for Long Term Care, Home and Community Care including Health Care offices and Ambulatory Clinics

Centre of Disease Control (2003), Guidelines for environmental infection control in healthcare facilities, MMWR, Vol. 52, No. RR10.

College of Physicians and Surgeons of Ontario (2004) infection Control in the Physicians Office

Health Canada (1998), Hand washing, cleaning and sterilization in health care. CCDR, Vol. 24S8. http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/98pdf/cdr24s8e.pdf

PIDAC (2006), Best Practices for Cleaning, Disinfection and Sterilization in all Healthcare Settings

PHAC (1998), Handwashing, Cleaning, Disinfection and Sterilization in Health Care, Vol.24S8

Taking the Mystery out of Chemical Disinfection, Nicole Kenny Director of Professional & Technical Services, Virox Technologies, CHICA May 2006.