Frequency of cleaning in hospitals

Environmental cleaning and disinfection of the hospital is mainly aimed at eliminating/reducing/controlling/isolating the reservoirs of organisms in the environment.

Different areas in the hospital can be broadly categorised into:

1. General Areas: Such areas in the hospital where only general traffic is present; admitted patients are not present; patient care activities and procedures are not performed; street clothes and footwear are worn. Such areas are circulation areas like corridors, open areas like parking spaces, registration area etc.
2. Patient Care Areas: All areas in the hospital where patients are admitted and patient care activities and procedures are performed. These areas include wards, Operation Theatres (OTs), laboratory etc.

Factors influencing the cleaning frequency and level of disinfection

1. Potential for Direct Patient Contact : All surfaces in the hospital which can be under direct contact with patients should be more frequently cleaned with high/low level disinfectants as appropriate for the type of area. Cleaning and disinfecting such environmental surfaces is fundamental in reducing their potential contribution to the incidence of hospital acquired infections (eliminating the reservoirs in the chain of infection).
2. Type of Surface and Orientation (vertical//horizontal) : Dry conditions favour the persistence of gram-positive cocci (e.g., coagulase-negative Staphylococcus spp.) in dust and on surfaces, whereas moist, soiled environments additionally favour the growth and persistence of gram-negative bacilli and fungi.Horizontal surfaces catch more dust and microbes and therefore may require more frequent cleaning.
3. Degree and Frequency of Hand Contact
• High Touch Surfaces are those that have frequent contact with hands. Examples include doorknobs, elevator buttons, telephones, bedrails, light switches, computer keyboards, monitoring equipment, haemodialysis machines, wall areas around the toilet and edges of curtains in the patient area. Transmission of microbes from these surfaces to the patient directly or indirectly is more likely. Such surfaces require more frequent cleaning.
• Low Touch Surfaces are those that have minimal contact with hands. Examples include floors, walls, ceilings, mirrors and window sills. Potential for infection transmission from these surfaces is low and they require less frequent cleaning. However, they should be cleaned as soon as possible when visibly soiled
4. Potential for Contamination with Pathogens : Probability of contamination of a surface depends upon the nature of activity, pathogens involved and the microbial load. Contamination with blood//body fluids is taken as a measure of this. Based on this, hospital area//surfaces can have:
• Heavy Contamination: Surfaces and/or equipment are exposed to copious amounts of blood or other body fluids (e.g., OTs, labour room, autopsy room, cardiac catheterisation laboratory, burn unit, haemodialysis unit, Casualty Department, bathroom if the patient has diarrhoea or is incontinent).
• Moderate Contamination: Surfaces and/or equipment are contaminated with blood or other body fluids as part of routine activity (e.g., patient room, bathroom if patient is incontinent) and the contaminated substances are contained or removed (e.g., soiled bed sheets). All patient rooms and bathrooms should be considered to be, as a minimum, moderately contaminated.
• Light Contamination: An area is considered to be lightly contaminated or not contaminated if surfaces are not exposed to blood, other body fluids or items that have come into contact with blood or body fluids (e.g., lounges, libraries, offices, general traffic areas). 
5. Nature of Activity (critical care, meetings etc.) : The nature of activity generally influences the exposure of surfaces/equipment to blood and body fluids e.g., critical care area versus meeting rooms.
6. Vulnerability of Persons Present in the Area : Susceptibility to infection varies among different types of patients.
• More Susceptible: These are patients who are more susceptible to infection due to their medical condition or lack of immunity. These include those who are immune-compromised neonates; those who have severe burns; and those undergoing invasive or operative procedures (e.g., haemodialysis). Patients with sterile tissues exposed/sterile devices inserted in major blood vessels or body tracts e.g., central lines, endotracheal tubes for more than 24 hours are also more susceptible to infection. Patients with peripheral IV cannulation, urinary catheter insertion and intramuscular injections are excluded from this category unless they have some medical condition causing lack of immunity.
• Less Susceptible: For the purpose of risk stratification for cleaning, all other individuals are classified as less susceptible.

Source: Guidelines For Implementation Of "KAYAKALP" Initiative

Detailed Frequency of cleaning

Moderate risk area wards

Canteen and kitchen

Public area washroom

Lobby and open area

Stores (Medical surgical, Non-medical)

Mortuary

Administration record/Engineering office

CSSD / Laundry

Radiology laboratory

Note: A neutral detergent and warm water solution should be used for all routine and general cleaning. When a disinfectant is required for surface cleaning, e.g. after spillage or contamination with blood or body fluids, the manufacturer’s recommendations for use and occupational health and safety instructions should be followed.

Cleaning and disinfection frequency and level for various area of the hospital

Sources:

1. Guidelines For Implementation Of "KAYAKALP" Initiative
2. Swachhta Abhiyaan Guidelines for Public Health Facilities