It is crucial to ensure surfaces and environments in healthcare settings are cleaned thoroughly and properly in order to prevent infection transmission and keep patients, staff and visitors safe and healthy.
Healthcare-associated infections (HAIs) can be transmitted in any healthcare setting with approximately 165 000 cases occurring per year, potentially leading to poor patient outcomes, adding extra costs and increasing patient length of stay in hospital (NHMRC 2019).
In addition to patients, HAIs also pose a risk to staff or any other people who enter a healthcare facility (NHMRC 2019).
Therefore, the effective implementation of infection prevention and control is crucial to ensure that high quality healthcare is provided to patients, and a safe working environment is maintained for staff (NHMRC 2019).
Successful infection prevention and control relies on a sound understanding of the modes of transmission and when preventative measures should be taken. This is the responsibility of not only healthcare staff, but also visitors, patients, carers and administrators (NHMRC 2019).
How are HAIs Transmitted?
Infectious agents or pathogens are disease-causing microorganisms that comprise bacteria, viruses, fungi and parasites (NHMRC 2019).
Many of these infectious agents exist in healthcare settings, in most cases originating from human sources (patients and staff). They are most commonly transmitted to others through contact (direct or indirect), droplet or airborne routes (NHMRC 2019).
The spread of these infectious agents between susceptible ‘hosts’ is a process known as the chain of infection, and preventing transmission relies on inhibiting the chain at any of its six links:
Use of PPE according to the task being undertaken and level of risk;
Appropriate handling of sharps, waste and linen;
Respiratory hygiene and cough etiquette;
Environmental cleaning and reprocessing of equipment and instruments; and
Cleaning of shared patient equipment.
(SA Health 2017; ACSQHC 2019; NHMRC 2019)
Additional measures designed to interrupt a specific infectious agent and its mode of transmission.
Used to control infection risk with patients who are suspected or confirmed to be in contact with infectious agents transmitted by contact, airborne or droplet routes.
Used during outbreaks.
Used if standard precautions alone are insufficient.
They may include:
Isolation in a room (with or without negative pressure ventilation); and
Enhanced cleaning of the room with detergent and disinfectant (both while the patient is present and when the room is vacant); and
(SA Health 2017; ACSQHC 2019; SA Health 2020)
Environmental Surface Cleaning
Environmental surface cleaning relates to the cleaning of surfaces and objects in order to reduce contamination from infectious agents that may be present, and as a result prevent cross-infection (SA Health 2019).
The act of cleaning aims to remove foreign materials including dust, soil, blood, secretions, excretions and micro-organisms from surfaces and objects. This is achieved through a combination of water, detergent and friction (SA Health 2017).
According to the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019), it is good practice to clean as follows:
High-touch surfaces (e.g. door handles, bed rails, tabletops, light switches) should be cleaned daily with a detergent solution, when visibly soiled and after every known contamination.
Low-touch surfaces (e.g. floors, ceilings, walls, blinds) should be cleaned when visibly soiled and right after spillage.
(NHMRC 2019; DoH 2020)
Additionally, wet areas such as toilets, sinks, baths, showers and basins should be cleaned at least daily, and more frequently if needed (VIC Health n.d.).
There are two types of chemicals used for cleaning in healthcare settings:
Detergents remove dirt and organic matter. They are used as a general cleaning agent and are usually sufficient for most surfaces.
Disinfectants can kill or deactivate infectious agents, but do not have a cleaning effect and may be inactivated by soil. Therefore, in order to function effectively they should be used in conjunction with detergents when necessary, but not as a general cleaning agent.
(SA Health 2017; DoH 2020)
Cleaning solutions should be prepared right before use (VIC Health n.d.).
Remember to follow workplace health and safety instructions and the manufacturer’s recommendations before using a disinfectant (VIC Health n.d.).
Generally, the following principles apply to equipment used for cleaning:
Equipment that disperses dust (e.g. broom) or generates aerosols (e.g. spray bottle) should be avoided as it may cause irritation.
Single-use cleaning items are preferable.
Reusable cleaning items (solutions, water, buckets, cloths and mop heads) should be changed after each use, and changed immediately if used to clean a body substance spill.
Buckets should be emptied, washed with detergent and warm water, rinsed with hot water and dried upside-down between uses.
Mops should be laundered or washed with detergent and warm water, rinsed with hot water and dried between uses.
(SA Health 2017; VIC Health n.d.)
In order to reduce and control the spread of infection, it is important to adhere to appropriate cleaning techniques, as incorrect cleaning may encourage the spread of microorganisms rather than remove them (SA Health 2017). The following principles generally apply:
Cleaning should start at the cleanest areas first (low-touch and lightly soiled) before moving to the dirtiest areas (high-touch and heavily soiled) last. For example, in a bathroom the toilet should generally be cleaned last.
Cleaning should start at high-reach surfaces before moving to low-reach services.
Dusting techniques should not disperse dust (i.e. dust high-reach areas first and use a damp cloth).
Cleaning should be performed in a methodical manner.
When using cloths and a bucket:
Avoid double-dipping used cloths into a bucket where there are clean cloths, as this will contaminate them.
Rotate and fold cloths as they are used in order to maximise their use.
Remember that high-touch surfaces may require more cloths than low-touch surfaces.
(SA Health 2017)
Types of Cleans
The minimum cleaning that should be routinely conducted regardless of whether surfaces appear visibly dirty.
Conducted when there are patients on transmission-based precautions.
Single clean: The case is standalone (or there are several unrelated cases).
Outbreak clean: There are multiple related cases of the infection in one area.
Discharge (terminal) clean:
Cleaning of specific elements after the permanent vacation of a patient (discharge, transfer, death).
Standard discharge clean.
Transmission-based discharge clean if the patient has been on transmission-based precautions.
Spot and spill clean:
To be performed whenever a surface is visibly soiled or there is a body fluid spillage.
(SA Health 2017)
Please note that each healthcare facility should have its own internal policies and procedures in place regarding cleaning. Staff should refer to the policies and procedures of their own workplace.
National Health and Medical Research Council 2019, Australian Guidelines for the Prevention and Control of Infection in Healthcare, National Health and Medical Research Council, viewed 6 April 2020, https://app.magicapp.org/app#/guideline/4116