Best Practices for Environmental Cleaning
Module 4 – General Cleaning
Part A - Cleaning Principles
Learning Objectives
1. To identify factors that determine frequency of
cleaning.
2. To correctly sequence tasks for cleaning.
3. To demonstrate proper procedures for different
cleaning applications.
4. To describe other considerations in environmental
management (e.g. waste handling, sharps safety,
biological spill cleaning)
2
General Cleaning
These principles apply to all settings
where “hospital clean” is required.
3
Hotel Clean & Hospital Clean
Hotel Clean:
• is a measure of cleanliness based on visual appearance that
includes dust and dirt removal, waste disposal and cleaning of
windows and surfaces.
Hospital Clean is a hotel clean PLUS:
• High touch surfaces in patient/resident/client care areas are
cleaned and disinfected with hospital grade disinfectant
• Non-critical medical equipment is cleaned and disinfected
between patients/residents/clients AND
• Cleaning practices are periodically monitored and audited with
feedback and education
4
Cleaning Frequencies –
Factors Influencing Frequency
• Surfaces high-touch or low-touch

Door knob vs window sill
• Type of activity taking place in the area and risks associated with the
activity

Critical care vs office setting
• Vulnerability of patients/residents housed in the area

Intensive care vs patient/resident room
• Probability of contamination based on the amount of body fluid
contamination in the area

Washroom vs lounge
• Presence of antibiotic resistant organisms (AROs)
5
Cleaning Frequencies –
Factors Influencing Frequency
High-Touch Surfaces:
• Are those that have frequent contact with
hands. Examples: doorknobs, elevator buttons,
telephones, call bells, bedrails, light switches,
computer keyboards, etc.
• High-touch surfaces in care areas require more
frequent cleaning and disinfection than minimal
contact surfaces. Cleaning and disinfection is usually
done at least daily and more frequently if the risk of
environmental contamination is higher e.g. in
intensive care units, during outbreaks.
6
Cleaning Frequencies –
Factors Influencing Frequency
High-touch surfaces
How many high touch
surfaces can you identify
in this picture?
High-touch surfaces
Examples of High-touch Items and Surfaces in the Health Care Environment
NOTE: Dots indicate areas of highest contamination and touch
Figure 1
7
Cleaning Frequencies –
Factors Influencing Frequency
High-touch surfaces
More examples of high-touch Items and Surfaces in the Health Care Environment.
Note: the dots indicate areas of highest contamination and touch
8
Cleaning Frequencies –
Factors Influencing Frequency
Low-Touch Surfaces:
• Are those that have minimal contact with hands.
Examples - floors, walls, ceilings, mirrors and window
sills.
• Require cleaning on a regular (but not necessarily
daily) basis, when soiling or spills occur, and when a
resident is discharged from the health care setting.
• Many low-touch surfaces may be cleaned on a
periodic basis rather than a daily basis if they are
also cleaned when visibly soiled.
9
Cleaning Frequencies –
Factors Influencing Frequency
High-Touch vs Low-Touch Surfaces:
• The frequency of cleaning and the level of cleaning
are dependent upon the risk classification of the area
to be cleaned
10
Factors that Impact Cleaning
• Factors that will impact the frequency of
environmental cleaning include:
 Probability of contamination with pathogens
 Vulnerability of clients/patients/residents to
infection
 Potential for exposure
11
Probability of contamination
• Heavy – surfaces/equipment routinely exposed to
copious amounts of fresh blood or other body fluids
(e.g. birthing suite, ER, bathrooms if visible soil)
• Moderate – surfaces/equipment does not routinely (but
may) become contaminated with blood or body fluids (all
bathrooms)
• Light – surfaces not exposed to blood or other body fluids
or items that have contact with these (e.g. lounges,
libraries, offices)
12
Vulnerability to infection
• Vulnerability of client/patient/resident
 More susceptible – those who are susceptible to infection
due to medical condition or lack of immunity e.g. elderly individuals
who have underlying illnesses
 Less susceptible – all other individuals and areas
• Potential for exposure
 High-touch surfaces – those that have frequent contact with hands
 Low-touch surfaces – those that have minimal contact with hands
13
Risk Stratification
• Determine the risk
Probability of
Contamination with
pathogens
High-touch surfaces
(score = 3)
Low-touch surfaces
(score = 1)
More
Less
More
Less
susceptible susceptible susceptible susceptible
Score=1
Score=0
score=1
Score=0
Heavy
Score=3
7
6
5
4
Moderate
Score=2
6
5
4
3
Light
Score=1
5
4
3
2
14
Risk Stratification Matrix
• Determine the cleaning frequency based on risk
stratification matrix
Total Risk
Score
Risk Type
Minimum Cleaning Frequency
High Risk
Clean after each case/event/procedure
and at least twice per day
Clean additionally as required
4-6
Moderate Risk
Clean at least once daily
Clean additionally as required (e.g.
gross soiling)
2-3
Low Risk
Clean according to a fixed schedule
Clean additionally as required (e.g.
gross soiling)
7
15
Example - Hospital
An Intensive Care Unit:
• Probability of contamination is heavy = 3
• Potential for exposure is high (high touch) = 3
• Vulnerability of patients in ICU - more susceptible = 1
• Total score = 7 – Clean at least twice per day and
additionally as required e.g. if gross soiling
16
Example - LTC
A Resident Activity Room:
• Probability of contamination is moderate = 2
• Potential for exposure is high (high touch) = 3
• Vulnerability of residents – Those participating in
activities may be considered less susceptible = 0
• Total score = 5 – Clean at least once daily and
additionally as required e.g. if gross soiling
17
Learning Checkpoint
18
Learning Checkpoint
• Identify whether the following items are ‘high-touch’ or
‘low-touch’ surfaces.
 Toilet handle
 Soap dispenser
 Baseboard
 Wall
 Bathroom mirror
 Faucet handles
 Window coverings
 Ceiling lights
19
Learning Checkpoint Answers
• The correct answers are:
 Toilet handle - high
 Soap dispenser - high
 Baseboard - low
 Wall – low
 Bathroom mirror – low
 Faucet handles - high
 Window coverings – high/low depending on setting – use
risk stratification matrix
 Ceiling lights - low
20
References
Fig 1-2:
Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Environmental
Cleaning for Prevention and Control of Infections in All Health Care Settings. 2009 [cited March 27,
2013]:28-29 Available from:
http://www.oahpp.ca/resources/documents/pidac/Best%20Practices%20for%20Environmental%20
Cleaning.pdf
21
Thank You!
Image Sources –
Module 4A
• Microsoft Clipart used in Slide 18
• Images in slides 7, 8 & 10 are © PHO 2013