environmental cleaning

Question 1

What type of cleaning is used for a multidrug organism ?

Answer 1

Enhance environmental cleaning

Question 2

CDC recommends which disinfectant to be used for cleaning surfaces?

Answer 2

EPA registered disinfectant

Question 3

If an EPA disinfectant is removed from its original bottle how should the second bottle be labeled?

Answer 3

1. Chemical name
2. Concentration
3. Expiration date

Question 4

Have an interdisciplinary team select disinfectants for use in the perioperative setting based on the following factors:

Answer 4

1. Environmental Protection Agency (EPA) registration and hospital-grade rating
2. targeted microorganisms
3. contact times
4. manufacturers’ instructions for use (IFU)
5. compatibility with surfaces, cleaning materials, and equipment
6. patient population (eg, neonatal)
7. cost
8. safety
9. effect on the environment

Question 5

Do not use these to clean and disinfect environmental surfaces or noncritical devices.

Answer 5

high-level disinfectants or liquid chemical sterilants

Question 6

Do not use alcohol (ie, ethyl alcohol 60%– 90%, isopropyl alcohol 60%–90%) to disinfect

Answer 6

large environmental surfaces (eg, tables, OR bed)

Question 7

Cleaning chemicals must be prepared, handled, used, stored, and disposed of in accordance with

Answer 7

manufacturers’ IFU and local, state, and federal regulations

Question 8

if the cleaning chemical is removed from the original container, the secondary container must

Answer 8

immediately be labeled with the chemical name, concentration, and expiration date

Question 9

These must be available and reviewed for each cleaning chemical used in the perioperative setting

Answer 9

Safety data sheets

Question 10

Do not use a spray bottle to apply disinfectants to environmental surfaces in the perioperative practice setting.

Answer 10

Disinfectants may be applied by a cloth or poured onto environmental surfaces in a manner that prevents splashing

Question 11

Have an interdisciplinary team select cleaning materials, tools, and equipment based on the following factors:

Answer 11

surface composition of the items to be cleaned,21,36

manufacturers’ IFU for cleaning materials and equipment,21

compatibility with detergents and disinfectants,21,37

durability and life cycle,21,22,36

cost,21

personnel ergonomics and safety,21 and

effect on the environment

Question 12

Determine whether to select reusable or single-use cleaning materials (eg, mop heads, cloths) based on the following factors:

Answer 12

laundering processes,

laundry turnaround time,

size of the areas to be cleaned,

frequency of cleaning,

cost,

effect on the environment, and

storage space

Question 13

Before storage and reuse, disassemble cleaning equipment according to the manufacturers’ IFU, then clean, disinfect with an EPA-registered disinfectant, and dry the equipment

Answer 13

Cleaning the equipment prevents the growth of microorganisms during storage and prevents subsequent contamination of the perioperative area

Question 14

Identify high-touch objects and surfaces to be cleaned and disinfected.

Answer 14

When cleaning high-touch objects, clean the frequently touched areas of the item (eg, control panel, switches, knobs, work area, handles)

Question 15

Perform cleaning activities in a methodical pattern that limits the transmission of microorganisms.

Answer 15

1. When cleaning with the same cleaning material (eg, cloth, wipe, mop head), progress from clean to dirty areas.
2. When cleaning and damp dusting, progress from top to bottom.
3. The room may be cleaned in a clockwise or counter-clockwise direction in conjunction with clean-to-dirty and top-to-bottom methods

Question 16

Do not return used cleaning materials (eg, mop heads, cloths) to the cleaning solution container

Answer 16

Used cleaning materials are considered contaminated and returning them to the cleaning solution container contaminates the solution.

Question 17

Always consider floors in the perioperative practice setting to be contaminated.

Answer 17

1. Consider items that contact the floor for any amount of time to be contaminated
2. Clean and disinfect noncritical items (eg, safety straps, positioning devices) per the manufacturer’s instructions after these items contact the floor

Question 18

Mop floors with damp or wet mops. Do not dust the floor with a dry mop in semi-restricted and restricted areas

Answer 18

When mopping, progress from the cleanest to dirtiest areas of the floor
The center of the room, where most of the patient care occurs, is most likely to have higher levels of contamination

Question 19

After each patient use, clean and disinfect reusable noncritical, nonporous surfaces such as mattress covers, pneumatic tourniquets, blood pressure cuffs, and other patient equipment according to the manufacturers’ instructions.

Answer 19

Clean and disinfect patient transport vehicles including the straps, handles, side rails, and attachments after each patient use.
Discard single-use items after each patient use

Question 20

Apply a protective barrier covering to noncritical equipment surfaces if the surface cannot withstand disinfection or is difficult to clean (eg, computer keyboards, foot pedals, touchscreen computer monitors)

Answer 20

If a protective barrier covering is used, remove or clean and disinfect the cover per the manufacturer’s IFU after each patient use
Clean noncritical medical equipment that cannot be covered and cannot withstand disinfection (eg, robots, imaging system components) in accordance with the equipment manufacturers’ IFU.

Question 21

Before cleaning, inspect mattresses and padded positioning device surfaces (eg, OR beds, arm boards, patient transport carts) for any moisture, stains, or damage.

Answer 21

Remove and replace damaged or worn mattress coverings according to facility policy and the manufacturer’s instructions
Avoid penetration of the mattress by needles and other sharp items

Question 22

Standard precautions must be followed when cleaning, to prevent contact with blood, body fluids, or other potentially infectious materials

Answer 22

Personal protective equipment (PPE) must be worn during handling of contaminated items or cleaning of contaminated surfaces, to reduce the risk of exposure to blood, body fluids, and other potentially infectious materials.

Gloves must be worn when it is reasonably anticipated that there may be contact with blood, body fluids, or other potentially infectious materials during handling or touching of contaminated items or surfaces.

Masks, eye protection, and face shields must be worn whenever contact with splashes, spray, splatter, or droplets of blood, body fluids, or other potentially infectious materials is anticipated.

Wear respiratory protection (ie, an N95 respirator, a powered air-purifying respirator) if cleaning procedures are expected to generate infectious aerosols.

Perform hand hygiene after PPE is removed and as soon as possible after hands are soiled

Question 23

Take the following steps when cleaning a spill of blood or body fluids:

Answer 23

Apply an EPA-registered disinfectant that is effective against bloodborne pathogens (eg, human immunodeficiency virus, hepatitis B virus) to the spill.25

Soak up the spill with an absorbent material (eg, lint-free towel, absorbent gel) and discard it.

Clean and disinfect the surface

When an EPA-registered disinfectant is not available, a freshly diluted sodium hypochlorite solution may be used

Question 24

Items that would release blood, body fluids, or other potentially infectious materials in a liquid or semi-liquid state if compressed and items that are caked with dried blood, body fluids, or other potentially infectious materials must be placed in closable, leak-proof containers or bags that are color coded, labeled, or tagged for easy identification as biohazardous waste

Answer 24

Manage waste generated during care of patients on transmission-based precautions in accordance with standard waste management procedures per local, state, and federal regulations.

Question 25

Containers or bags containing what must be transported in closed, impervious containers according to state and federal regulations.

Answer 25

regulated medical waste

Question 26

Immediately or as soon as possible after use, contaminated sharps (eg, needles, blades, sharp disposable instruments) must be discarded in a closeable, puncture-resistant container that is leak proof on its sides and bottom and is labeled or color coded

Answer 26

Sharps containers must not be overfilled.

Broken glassware must not be touched with hands
Use mechanical means, such as forceps, tongs, or a dustpan to handle broken glass.

Question 27

Laundry contaminated with blood, body fluids, or other potentially infectious materials must be handled as little as possible

Answer 27

Contaminated laundry must be placed in labeled or color coded containers or bags at the location where it was used.
Contaminated laundry that is wet and may soak or leak through the container or bag must be placed and transported in closed containers or bags that prevent soak-through or leakage of fluids to the exterior

Question 28

Damp dust all horizontal surfaces (eg, furniture, surgical lights, booms, equipment) before the first scheduled surgical or other invasive procedure of the day

Answer 28

Complete damp dusting before case carts, supplies, and equipment are brought into the room.

Use a clean, low-linting cloth moistened with a disinfectant to damp dust

Question 29

Operating and procedure rooms must be cleaned and disinfected after each patient procedure

Answer 29

Do not begin environmental cleaning, including trash and contaminated laundry removal, until the patient has left the OR or procedure room.8,21 [Recommendation]Expand/Collapse section link

4. 2.2Remove trash and used linen from the room21 (See Recommendation 3). [Recommendation]
5. 2.3Clean and disinfect all items used during patient care, includingExpand/Collapse section link
6. 2.4Clean and disinfect the floor with a mop after each surgical or invasive procedure when visibly soiled or potentially soiled by blood or body fluids (eg, splash, splatter, dropped item).1,8,21,38,82 [Recommendation]
7. 2.5Spot clean and disinfect the walls after each surgical or invasive procedure when visibly soiled.

Question 30

Performing terminal cleaning or closing the OR after a contaminated or dirty/infected procedure (ie, Class III, Class IV) is not necessary. If the patient is infected or colonized with an MDRO, implement

Answer 30

enhanced environmental cleaning procedures

Question 31

Terminally clean operating and procedure rooms each day the rooms are used.

Answer 31

Clean and disinfect the exposed surfaces, including wheels and casters, of all items, includingExpand/Collapse section link
Clean and disinfect the entire floor, including areas under the OR bed and mobile equipment,21 using either a wet vacuum or mop

Question 32

Preoperative and postoperative patient care areas must be cleaned after each patient has left the area

Answer 32

Clean and disinfect mobile and fixed equipment (eg, suction regulators, medical gas regulators, imaging viewers, radiology equipment, warming equipment) that is used during patient
Clean and disinfect the floor with a mop when visibly soiled or potentially soiled by blood or body fluids (eg, splash, splatter, dropped item)
Spot clean and disinfect the walls when visibly soiled.

Question 33

Clean and disinfect items that are used during patient care, including

Answer 33

patient monitors,43,79

infusion pumps and IV poles,79,101

patient beds or stretchers,43,44,77,102,103

over-bed tables,2,40,43,44,77,79,102-107

television remote controls,44,102,103 and

call lights

Question 34

Terminally clean the preoperative and postoperative patient care areas each day the areas are used.

Answer 34

5. 2.1Clean and disinfect the exposed surfaces, including wheels and casters, of all items in the area, includingExpand/Collapse section link
6. 2.2Clean and disinfect the entire floor, including areas under mobile equipment,21 using either a wet vacuum or mop

Question 35

Damp dust all horizontal surfaces in the sterilization packaging area (eg, countertops, workstations) at least daily

Answer 35

Use a clean, low-linting cloth moistened with a disinfectant to damp dust

Question 36

*If preventive measures fail to eliminate the cause of the infestation, consult a credentialed pest control specialist

Answer 36

Terminally clean the area after an infestation is resolved

Question 37

*If flooding or a water-related emergency occurs, including sewage intrusion, inspect the area for water damage and implement a cleaning and disinfection process

Answer 37

When surfaces remain in good repair, allow them to dry for 72 hours and perform terminal cleaning

When surfaces are damaged or cannot dry within 72 hours, perform remediation to replace the surface with new materials after the facility engineer determines that the underlying structure is dry

Question 38

Implement enhanced environmental cleaning procedures following the care of patients who are known or suspected to be infected or colonized with MDROs, including

Answer 38

MRSA,

VRE,

vancomycin-intermediate Enterococcus species,

vancomycin-resistant S aureus,

vancomycin-intermediate S aureus,

carbapenem-resistant Enterobacteriaceae,

multidrug-resistant Acinetobacter species,

Candida auris,109

extended spectrum beta-lactamase-producing organisms, and

Klebsiella pneumoniae carbapenemase-producing organisms.48,87,101,110-114

Question 39

Implement enhanced environmental cleaning procedures following the care of patients who are known or suspected to be infected or colonized with MDROs, including

Answer 39

MRSA,

VRE,

vancomycin-intermediate Enterococcus species,

vancomycin-resistant S aureus,

vancomycin-intermediate S aureus,

carbapenem-resistant Enterobacteriaceae,

multidrug-resistant Acinetobacter species,

Candida auris,109

extended spectrum beta-lactamase-producing organisms, and

Klebsiella pneumoniae carbapenemase-producing organisms.48,87,101,110-

Clean and disinfect all items touched during patient care, includingExpand/Collapse section link
8.1.2In addition to standard precautions, wear a gown and gloves when performing enhanced environmental cleaning procedures.

Question 40

Restrict room access following the care of a patient diagnosed with or suspected of infection with an airborne transmissible disease (eg, tuberculosis) and following aerosolization activities (eg, intubation, extubation, cough-generating activities) of a patient diagnosed with or suspected of infection with a droplet transmissible disease (eg, influenza) until adequate time has passed for air exchanges per hour to remove 99% of airborne particles from the air (eg, 15 air exchanges per hour for 28 minutes to remove 99.9% of airborne contaminants

Answer 40

If entering the room before a complete air exchange occurs, wear respiratory protection (eg, an N95 respirator) to perform environmental cleaning.

Question 41

Use special cleaning procedures for environmental contamination with high-risk tissue (ie, brain, spinal cord, eye tissue, pituitary tissue) from a patient who is diagnosed with or suspected of having Creutzfeldt-Jakob disease (CJD). If the environment is not contaminated with high-risk tissue, follow routine cleaning procedures

Answer 41

Before the operative or invasive procedure begins, remove unnecessary equipment and cover work surfaces with a disposable, impervious material that can be removed and decontaminated after the procedure if contaminated with high-risk tissue.8,119 [Recommendation]Expand/Collapse section link

8. 5.2When linens are not contaminated with high-risk tissue, follow routine laundering processes.119 [Recommendation]
9. 5.3Clean noncritical environmental surfaces contaminated with high-risk tissue with a detergent and then decontaminate with a solution of either sodium hypochlorite (1:5 to 1:10 dilution with 10,000 ppm to 20,000 ppm available chlorine) or sodium hydroxide (1N NaOH), depending on surface compatibility.8,119 [Recommendation]Expand/Collapse section link
10. 5.4Perform cleaning and disinfection of surfaces contaminated with high-risk tissues in the following order:Expand/Collapse section link
11. 5.5Use standard cleaning procedures to disinfect surfaces that are not contaminated with high-risk tissue.119 [Recommendation]
12. 5.6Manage regulated medical waste generated during patient care, including waste that was contaminated by high-risk tissue and has been decontaminated, in accordance with standard waste management procedures per local, state, and federal regulations