Best Practices for Environmental Cleaning
MODULE 5 – Additional Precautions
Learning Objectives
1. Describe and demonstrate appropriate procedures
for cleaning rooms of clients/patients/residents on
additional precautions.
2. Describe and demonstrate appropriate procedures
for specialized cleaning.
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What are Additional
Precautions?
• Additional Precautions are necessary in addition to
Routine Practices for certain pathogens or clinical
presentations. These precautions are based on the
method of transmission (e.g. contact, droplet,
airborne). (PIDAC 2009)
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Principles of Additional Precautions
• Additional Precautions are used in addition to
Routine Practices for clients/patients/residents
known or suspected to be infected or colonized with
certain microorganisms to interrupt transmission.
• Additional Precautions include the use of barriers,
such as PPE, and additional environmental controls
that are put in place for encounters with the
client/patient/resident or their immediate
environment. In some instances, specialized
engineering controls or enhanced cleaning protocols
may be required.
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Additional Precautions
• Additional Precautions are based on the mode of
transmission
• There are three categories of Additional Precautions:
 Contact Precautions
 Droplet Precautions
 Airborne Precautions
• The practices used in Additional Precautions may
vary with the type of health-care setting
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Elements of Additional Precautions
Routine Practices
Specialized Accommodation and Signage
Barrier Equipment
Dedicate Equipment and Additional Cleaning Measures
Limited Transport
Communications
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Learning Checkpoint
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Learning Checkpoint
• Which of the following is a true statement about
Additional Precautions?
a) Additional precautions should be used only when
your supervisor informs you of these.
b) Additional precautions are used in addition to
Routine Practices to care for some
clients/patients/residents.
c) Additional precautions are used only by nursing staff.
d) Additional precautions are the same in all healthcare settings.
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Learning Checkpoint Answer
• The correct answer is: b – Additional precautions are
always used with routine practices when you are
working with some clients/patients/residents who
have specific germs or symptoms that may be
transmitted to other clients/patients/residents/staff
and/or visitors in the health-care setting.
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Contact Precautions
• Routine Practices plus:
 PPE as indicated on
signage
 VRE and C. difficile require
special cleaning
 All high touch surfaces must
be cleaned at least daily
 Remove and launder all
curtains when visibly soiled
and on discharge/vacancy
cleaning
Sample sign only
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Contact Precautions –
C. difficile environmental cleaning
• Daily cleaning – clean room twice per day
• In addition to routine cleaning:
 Use a fresh bucket and mop head for each room
 After cleaning, apply a sporicidal disinfectant to all
surfaces and ensure sufficient contact time (if product used
for cleaning is sporicidal this step is not necessary)
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Contact Precautions –
C. difficile environmental cleaning
• Discharge cleaning – double cleaning
 Use when precautions are discontinued or resident/patient
discharged or transferred
 Remove all dirty/used items
 Remove curtains
 Discard all disposable supplies
 Use fresh cloths, mop, supplies and solutions to clean the
room for each cleaning
 Ensure appropriate contact time for disinfectant
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Contact Precautions –
VRE environmental cleaning
• Daily cleaning
• In addition to routine cleaning:
 Use a fresh bucket and mop head for each VRE room
 If a low-level disinfectant is not used for cleaning; then
apply a low-level disinfectant after cleaning to all surfaces
and ensure sufficient contact time
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Contact Precautions –
VRE environmental cleaning
• Discharge cleaning:
 Use when precautions are discontinued or resident/patient
discharged
 Remove all used/dirty items
 Remove curtains
 Discard all disposable supplies
 Use fresh cloths, mop, supplies and solutions to clean room
 Ensure appropriate contact time for the disinfectant
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Droplet Precautions
• Routine Practices plus:
 PPE as indicated on signage
 Routine cleaning of
patient/resident room
 All high touch surfaces in the
room must be cleaned at
least daily
Sample sign only
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Airborne Precautions
• Routine Practices plus:
 Fit-tested N95 respirator on
entry to room
 Routine cleaning of
patient/resident room
 All high touch surfaces in the
room must be cleaned at least
daily
 Room to be at negative
pressure to other adjacent
areas
Sample sign only
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Combinations of Additional Precautions
• Some microorganisms may have more than one way
of being transmitted. In these instances a
combination of Additional Precautions may be used.
 E.g. Respiratory viruses may be spread through droplets
and indirect contact with objects in the immediate
environment, therefore both Droplet and Contact
Precautions are used.
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Learning Checkpoint
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Match the correct statement to the
type of Additional Precaution
• Fit-tested N95 respirator • Contact Precautions
required
• Airborne Precautions
• Room to be cleaned
using a sporicidal agent • Droplet Precautions
• Disposable supplies to
be discarded during
discharge clean
• Contact Precautions –
VRE
• Contact Precautions –
C. difficile
• PPE includes mask and
eye protection
• Droplet and Contact
Precautions
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Learning Checkpoint Answer
• Fit-tested N95 respirator required – Airborne
Precautions
• Room to be cleaned using a sporicidal agent –
Contact Precautions C. difficile
• Disposable supplies to be discarded during
discharge clean – 2 correct answers – Contact
Precautions – VRE and Contact Precautions – C.
difficile
• PPE includes mask and eye protection – Droplet
Precautions
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When you return to your job, what will you
do differently as a result of this session?
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Thank You!
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Image Sources –
Module 5
• Microsoft Office Clipart used in slides 7 & 18
• Images in slides 10, 15 & 16 are © PHO 2013
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