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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

S.No Activity Frequency Agents Used
1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Cleaning of Instruments After every procedure Soap & water followed by sterilization
3.
Cleaning of clean areas and corridors of complex Twice a day/ as & when required Damp Mop with detergent and water/ 0.5% chlorine
4.
Mopping. (Care to be taken in case of special epoxy flooring ) Thrice a day and after each procedure Damp mop with detergent and water / 0.5% chlorine
5. Cleaning of equipments like anaesthesia machines, monitors, ventilators, infant warmers/ baby cribs etc Twice a day/ as & when required Damp Mopping , dry, Disinfect with 70% isopropyl alcohol / 2% glutaraldehyde (For endoscopes & reusable items)
6. Fumigation Once a month/ After Infected case surgery Formaldehyde
7. Cleaning of OT table and OT stretcher Twice a day/ after each surgery 0.5% chlorine /70% Isopropyl alcohol
8. Doctor’s / nurses / technician room Twice a day Detergent & water
9. Washroom & wash basins cleaning Thrice a day and as & when required Wash with Soap & water,then dry, wipe 0.5% chlorine
10. Washing of slipper once a day and when required Soap & water
11. Collection of soiled linen and sluicing As and when required Soak in clean water with bleaching powder 0.5% for 30 minutes. Wash again with detergent and water to remove the Bleach. OR launder in hot water (70- 80 degree C) if possible.
12. Cleaning of Mops After every use Soak in clean water with bleaching powder 0.5% for 30 minutes. Wash again with detergent and water to remove the bleach

Moderate risk area wards

1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Mopping of floor Once a day Damp mop with detergent and water
3.
Washrooms & Wash basin Thrice a day and as & when required Wash with Soap & water, then dry, wipe with 0.5% chlorine
4.
Dusting / Cleaning of Equipment Once a day Damp Mopping , dry, Dis-infect with 70% isopropyl alcohol
5.
Collection of soiled linen and sluicing As and when required Soak in clean water with bleaching powder 0.5% for 30 minutes. Wash again with detergent and water to remove the Bleach.

Canteen and kitchen

1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Mopping of floor Once a day Damp mop with detergent and water
3.
Washrooms & Wash basin Once a day Wash with Soap & water,then dry, wipe with 0.5% chlorine
4.
Dusting / Cleaning of Equipment Once a day Duster

Public area washroom

1.
Cleaning Every 2nd hourly Damp mop with detergent and water
2.
Washrooms & Wash basin Thrice a day Wash with Soap & water,then dry, wipe with 0.5% chlorine.

Lobby and open area

1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Mopping of floor Once a day Damp mop with detergent and water
3.
Washrooms & Wash basin Once a day Wash with Soap & water,then dry, wipe with 0.5% chlorine
4.
Dusting / Cleaning of Equipment Once a day Duster

Stores (Medical surgical, Non-medical)

1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Dusting Once a day Duster
3.
Mopping of floor Once a day Damp mop with detergent and water

Mortuary

1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Dusting Once a day Duster
3.
Mopping of floor Once a day Damp mop with detergent and water
4.
Cleaning of autopsy table Once a day and after every procedure 0.5% chlorine / 70% isopropyl alcohol
5.
Drains Once a day Soap & Water

Administration record/Engineering office

1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Dusting Once a day Duster
3.
Mopping of floor Once a day Damp mop with detergent and water
4.
Dry Mopping Once a day Soft brush
5.
Washrooms & Wash basin Once a day Wash with Soap & water, then dry, wipe with 0.5% Chlorine

CSSD / Laundry

1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Dusting Once a day Duster
3.
Mopping & Washing of floor Twice a day Damp mop with detergent and water
4.
Mopping (CSSD) sterile areas Once a day 0.5% chlorine/ 70% Isopropyl alcohol
5.
Fumigation Once a month/ as an when required Formaldehyde
6.
Washrooms & Wash basin Once a day Wash with Soap & water,then dry, wipe with 0.5% chlorine

Radiology laboratory

1.
Garbage Removal Thrice a day and more when bags are 3/4th full As per the BMW guidelines
2.
Dusting of infrastructure Once a day Damp duster, dry , then wipe with
3.
Cleaning of equipments Once a week Damp cleaning , dry , 70% isopropyl alcohol
4.
Mopping & Washing of floor Twice a day Damp mop with detergent and water
5.
Washing of Slippers Once a week Detergent & water
6.
Washrooms & Wash basin Once a day Wash with Soap & water,then dry, wipe with 0.5% chlorine

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

Location

Risk classification

Routine cleaning frequency

Additional cleaning

Disinfection level required

Reagents to use

All ICUs

High risk

At  least thrice a day at fixed times

yes

High

Aldehyde based

Burn ward

Medium risk

At  least thrice a day at fixed times

As required

High

Aldehyde based

Casualty treatment area

High risk

At  least thrice a day at fixed times

yes

High

Aldehyde based

CSSD

Medium risk

At  least thrice a day at fixed times

As required

High

Aldehyde based

Echocardiography (No patients with respiratory infection)

Low risk

At  least thrice a day at fixed times

As required

Only  Cleaning/ low level disinfection

Only soap/ QUAT

General  public areas

Low risk

At  least thrice a day at fixed times

As required

Only  Cleaning/ low level disinfection

Only soap/ QUAT

Haemodialysis unit

High risk

At  least thrice a day at fixed times

yes

High

Aldehyde based

Labour room

High risk

At  least thrice a day at fixed times

yes

High

Aldehyde based

Laboratory

Medium risk

At  least thrice a day at fixed times

As required

High

Aldehyde based

Offices

Low risk

At  least thrice a day at fixed times

As required

Only  Cleaning/ low level disinfection

Only soap/ QUAT

Operation theatre

High risk

-Start of the day

-between cases

-end of the list

-detailed wash down

yes

High

Aldehyde based

General ward

Medium risk

At  least thrice a day at fixed times

As required

High

Aldehyde based

Patient rooms (Patient not on isolation precautions)

Low risk

At  least thrice a day at fixed times

As required

Low

QUAT

Patient rooms (Patient not on isolation precautions)

Medium risk

At  least thrice a day at fixed times

yes

High

Aldehyde based

Pharmacy

Low risk

At  least thrice a day at fixed times

As required

Low

QUAT

Physiotherapy

Low risk

At  least thrice a day at fixed times

As required

Low

QUAT

Procedure rooms

High risk

At  least thrice a day at fixed times

Yes

High

Aldehyde based

Radiology

Low risk

At  least thrice a day at fixed times

As required

Only  Cleaning/ low level disinfection

Only soap/ QUAT

Reception area

Low risk

At  least thrice a day at fixed times

As required

Only  Cleaning/ low level disinfection

Only soap/ QUAT

Respiratory therapy rooms / area

High risk

At  least thrice a day at fixed times

yes

High

Aldehyde based

Soiled linen collection area

Medium risk

At  least thrice a day at fixed times

As required

High

Aldehyde based

Sources:

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


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