Infectious disease wards

Cleaning tips

1. The room is to be washed with soap and water followed by cleaning with 0.5% chlorine solution. The walls if tiled is also washed with soap and water followed by disinfection with 0.5% chlorine and left to dry with the doors and window open.
2. The room can be fumigated with formaldehyde and kept sealed for at least 12 hours before opening the windows and doors to let the vapours evaporate. During fumigation the bed, mattress and pillow can be left inside the room.
3. The bed linen to be cleaned with 0.5% bleaching solution followed by cleaning with plain water & detergent or laundered in hot water (70-80 degree C) to remove bleach and sent separately for washing/ dry cleaned.
4. The blanket, mattress and pillow can be washed with detergent and water and then kept in the sun to dry before reuse.
5. The housekeeping staff working in the isolation ward must wear personal protection gear and take all the necessary precautions to prevent contracting disease.

Diseases requiring isolation

Cleaning process of Isolation Wards

• Cleaning of this area should preferably be done after cleaning other areas
• Additional PPE – disposable cap, mask, linen gown and if required, goggles - should be used during cleaning. These items should be put on just before entering the area and should be removed immediately after coming out. They should not be taken to other areas of the hospital without putting them in plastic bag first
• Prepare all cleaning equipment and chemicals before starting cleaning. All cleaning should be completed in one session. Use an HLD
• Wear cap, mask, gown and rubber gloves
• Enter the area. Keep door closed to prevent traffic. If patient has a respiratory infection, keep windows open
• Clean blood and body fluid spills first
• Remove all contaminated items and items to be replaced from the area – linen, curtains, waste, sharps containers, etc. Inspect the area to make sure no item is missed. Soiled linen should be put in plastic bags at the point of removal itself. Make sure sharps containers are closed tightly and handle carefully to prevent dropping the container. Segregate any waste at source by putting it into the appropriate container. Waste bags should be closed, tied and labelled before transport
• Change gloves and begin cleaning
• First clean and disinfect all patient care items dedicated to the area e.g., thermometers, blood pressure apparatus, tongue depressors, weighing scales, ambu bags, sterile containers placed in the area, etc. Do not take these to another location or use on another patient before they are cleaned and disinfected properly
• Begin cleaning the environment after this. General direction for cleaning – from clean to dirty and from top to down
• Begin cleaning from the periphery of the area e.g., clean doors, door handles, windows and walls first. Clean walls from top to down. Clean all wall mounted items (switches, hand rub bottles etc.). Wall cleaning may be done on alternate days unless soiling is frequent
• Next clean all floor based items – lockers, chairs, IV stands, waste bins etc. Pay particular attention to high touch surfaces like handles, bedrails. Make sure all horizontal surfaces are cleaned
• Clean the bed last
• Clean any attached toilets next
• Lastly clean the floor
• Gather used mops in a plastic bag to transport them to the cleaning and disinfection area. Mops and buckets used to clean this area should be cleaned and disinfected before using them in another area. Disinfectant bottles should be dedicated to the infected ward/rooms only and not used in other area
• Disposable cap and masks should be removed immediately and discarded in the correct bio-medical waste container. Linen gown should be removed without touching the outer side and bagged as soiled linen
• Wash and remove the utility gloves; wash hands with soap and water; disinfect them using an alcohol hand rub
• If any items are to be replaced in the area, do it now. Wear fresh PPE before entering the area
• Disinfect footwear by immersion in chlorine solution with 500-1000ppm chlorine for 5-10 minutes before using again. If they are soiled with blood and/or body fluids, first disinfect with chlorine solution before washing with soap and water using a brush.

Terminal Disinfection after Discharge of Infected Patients

Terminal disinfection of the room/ward should be done after discharge of infected patients. The aim of this procedure is to thoroughly clean and disinfect all items and surfaces in the room/ward (eliminate any reservoirs of infection) and prevent further transmission to patients admitted there and staff working in the area. Detailed cleaning and disinfection of all surfaces and removal/disinfection of all potentially infected patient care items (thermometers, stethoscopes, tongue depressors etc.) is very critical to reduce the risk.

Steps for terminal disinfection of an area:

• Determine whether the patient was on any particular isolation precautions – contact/droplet/ airborne. If so appropriate precautions should be taken during cleaning and disposal of waste
• Prepare for cleaning – gather the cleaning equipment and items to be replaced. Once cleaning begins, the cleaning staff should not go to other areas of the hospital until all cleaning is finished
• Clean hands and use an alcohol hand rub
• Put on utility gloves. Wear a cap, mask and gown if patients were on isolation precautions
• Walk through the area and make a list of items that should be replaced e.g., soap, empty alcohol hand rub bottles, towels, linen etc.
• Remove all contaminated items and items to be replaced from the area – linen, curtains, waste, sharps containers, etc. Inspect the area to make sure no item is missed. Soiled linen should be put in plastic bags at the point of removal itself. Make sure sharps containers are closed tightly and handle carefully to prevent dropping the container. Segregate any waste at source by putting it into the appropriate container. Waste bags should be closed, tied and labelled before transport
• Clean any spills of blood/body fluid first
• Change gloves and begin terminal cleaning. Use a disinfectant. Use the pour wipes technique. Do not use plain water or only soap and water
• General direction for cleaning – from clean to dirty and from top to down
• Begin cleaning from the periphery of the area e.g., clean doors, door handles, windows and walls first. Clean walls from top to down. Clean all wall mounted items (e.g., switches, hand rub bottles, etc.).
• Next, clean all floor based items – beds, lockers, chairs, IV stands, waste bins etc. Pay particular attention to high touch surfaces like handles, bedrails, etc. Make sure all horizontal surfaces are cleaned
• Clean and disinfect all patient care items dedicated to the area e.g., thermometers, blood pressure apparatus, tongue depressors, weighing scales, ambu bags, sterile containers placed in the area, etc. Do not take these to another location or use on another patient before they are cleaned and disinfected properly
• Cleaning the bed
• Check all sides of the mattress for soiling (replace the mattress if soiled)
• Wipe mattress with disinfectant (if there is waterproof cover). Otherwise, soiled mattresses should be replaced. Wipe the removed mattress with plenty of disinfectant and keep in bright sunlight until thoroughly dry. Thereafter check whether it is usable. If not discard the mattress
• Clean the entire bed (i.e., frame, side rails, wheels, etc.)
• Clean any attached toilets next
• Lastly clean the floor
• If possible, clean and disinfect the used mops now. If not possible, keep them aside for later cleaning and disinfection. Mops and cleaning equipment used to clean an infected area should be cleaned and disinfected before using them in another area
• Cap, masks and gown used for infected area cleaning should be removed using proper technique and bagged as soiled line
• Wash and remove the utility gloves and wash hands with soap and water
• Disinfect hands with an alcohol hand rub
• If fogging is to be done, go to the next step; otherwise proceed to one step after that
• Use the same OT HLD to fog the area. In case of aldehyde based chemical, use double concentration than what is used for routine OT fumigation. Close all doors and windows and cover electrical equipment with plastic covers. Run the fogger until a fog is seen in the air. Then turn off the machine, remove from the area and keep the area closed for at least one hour. Post a sign on the door and mention the hour until which the area should be kept closed on the sign
• When room is cleared to enter again, replace the linen, towels, waste collection bags and any other materials
• Inspect the area for cleanliness and check that all replaceable items have been replenished.

Source: : Guidelines For Implementation Of "KAYAKALP" Initiative