TEAM CLEANING IN A HEALTHCARE SETTING
by David Holsinger
Team Cleaning® is a flexible, efficient and cost-effective cleaning system that has been successful in
office buildings, school districts and other commercial environments. In recent years, Team
Cleaning has been tested in the healthcare industry with great success. However, to meet the
standards of healthcare infection control programs and regulatory agencies such as the Joint
Commission on Accreditation of Health Organizations (JCAHO) and the Occupational Safety and
Health Administration (OSHA), a different approach to Team Cleaning is required. To understand
why these changes are appropriate, you must first understand the basic philosophy of Team Cleaning.
Team Cleaning improves production time and the quality of cleaning by refining jobs/tasks to their
purist form, then transforming these functions into separate specialist positions. Unlike zone
cleaning, another industry standard, employees are not accountable for all cleaning tasks in an
assigned area, but form a staggered assembly line that allows each specialist to cooperatively
"assemble" their component of the cleaning program in a prescribed sequence and manner
throughout a facility.
The traditional Team Cleaning structure consists of four specialists:
1.
2.
3.
4.
Light Duty Specialist
Vacuum Specialist
Restroom Specialist
Utility Specialist
This configuration of specialists is very effective in non-medical facilities, but does not meet the
cleaning challenges and standards in a major health care environment. In October of 1994 at the
Kaiser Permanente Medical Center in Fontana, California, (a 1.2 million sq. ft. medical center), we
addressed this issue during the planning and test phases of Team Cleaning and developed a health
care model consisting of seven specialists. We expanded the existing "team" by adding three new
specialist positions, a medical waste specialist, mopping specialist, and a project specialist. The new
positions were extracted from duties that the light duty, restroom, and utility specialist performed.
We felt these changes would improve productivity and meet the following infection control and
regulatory guidelines that require:
1. The appropriate cleaning and disinfecting of all fixtures in inpatient and outpatient areas.
2. A cradle-to-grave medical waste control program for proper handling and transporting of solid
waste (regular trash), soiled linen, biohazardous waste, sharps containers (holding syringes,
blades, and broken glass), trace amounts of chemotherapy and pathology waste.
3. Adherence to OSHA Rule 29 Bloodborne Pathogen standards.
4. Universal Body Substance Precautions and PPE (personal protective equipment) guidelines.
From the light duty specialist we created a medical waste specialist position. The traditional light
duty specialist in a non-medical environment empties trash and recycling bins, dusts, picks up paper
clips, paper and pencils from the floor, and spot cleans door glass and other surfaces. In a healthcare
setting, the scope and demands of these tasks increase dramatically. "Emptying trash" includes the
removal of office-type refuse, recyclable materials, soiled linen (which is handled as an infectious
product), biohazardous waste, sharp containers and on a limited basis, trace amounts of
chemotherapy and pathology waste. In addition to dusting and spot cleaning, the light duty specialist
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would disinfect non-floor surfaces of clinical exam rooms, special procedure/minor surgery rooms,
utility rooms, labs, pathology/morgue work stations, central sterile supply, radiology exam roomsand also stock paper towel and soap dispensers in these areas.
The workload volume alone of transporting medical waste, solid waste, and recyclable waste from
our facility emphasized the need for the medical waste specialist position. For example, in 1996 the
Fontana medical center collected 17,167,379 lbs. of waste products and soiled linen.
(Breakdown of waste products and soiled linen in example l-A)
I-A
Solid Waste
Soiled Linen
Recycled Products
Biohazardous Waste
13,930,355 Ibs.
2,000,000 Ibs.
499,968 lbs.
737,056 Ibs.
By creating a medical waste specialist, we ensured consistency in the following regulatory
requirements and cleaning tasks:
1. Free from the duties of collecting waste, the light duty specialist can ensure appropriate levels of
hygienic and aesthetic cleanliness in the medical center's general internal physical environment.
2. All biohazardous waste containers are lined with red plastic liners labeled with a biohazardous
symbol. All biohazardous waste containers and transport carts are properly labeled. Bagging of
biohazardous waste takes place at the point of origin and each liner is individually tied.
Biohazardous waste is handled and transported through the facility by a trained specialist from
the point of origin to biohazardous waste holding area.
3. The fewest employees possible are exposed to medical waste products. Before the Team
Cleaning program, on a nightly basis, we had 40 housekeeping positions that were responsible
for the removal of biohazardous waste. By creating a medical waste specialist we reduced that
number to nine. This reduced our employee exposure rate to medical waste by 70%.
4. The light duty and medical waste specialist production time is increased by separating daily
cleaning and disinfecting of work areas from medical waste removal.
From the restroom specialist-a group that must daily clean 400 public and staff restrooms-we created
the mopping specialist. The traditional restroom specialist is responsible for stocking dispensers,
emptying restroom trash, cleaning and sanitizing fixtures and floors, sweeping / vacuuming and
mopping tile floors in restrooms. In Kaiser's initial team paradigm, all exam rooms, special
procedure/minor surgery rooms, utility rooms, labs, and radiology exam rooms have tile floors that
would be cleaned and mopped by the restroom specialist using the mop bucket on the restroom
service cart. Given our concern that cross contamination from public and staff restrooms to patient
care areas could occur, and given the existing workload volume of the restroom specialist, we created
a mopping specialist to handle cleaning and disinfecting floors in ancillary areas. By creating a
mopping specialist we ensured consistency in the following disinfecting and cleaning tasks:
1. Free from having to mop ancillary floors, the restroom specialist can concentrate on effective
restroom cleaning. Public and staff restrooms are consistently cleaned, disinfected and stocked
daily. This focused attention on restrooms has enhanced customer perception of overall facility
cleanliness.
2. All clinical care areas such as exam rooms, special procedure/minor surgery rooms, utility
rooms, lab work stations, and radiology exam rooms are mopped daily by the separate mopping
specialist which eliminates the opportunity of cross contamination from public and staff
restrooms.
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3. The restroom and mopping specialist production time is increased by separating daily restroom
cleaning, restocking, and disinfecting, from mopping of ancillary patient care tile floors.
From the utility specialist we created a project specialist. The traditional utility specialist polices and
vacuums stairwells, transports trash collected by the medical waste specialist from the floors to the
compactor, cleans brass, glass, blinds, deep cleans and refurbishes carpet/tile and performs light
maintenance. A project position was needed because of the workload involved in maintaining the
tile and carpet in our facility. By pulling the floor care duties from the utility specialist and creating
a project specialist we ensured consistency in the following regulatory requirements and cleaning
tasks:
1. The utility specialist would have time to properly transport medical waste. The transporting of
medical waste in a healthcare facility in the state of California is very time consuming because of
the state of California's Medical Waste Management Act that requires solid waste, soiled linen,
and biohazardous waste be transported to the appropriate holding area in separately labeled
transport carts.
2. Productivity and consistency in scheduled project cleaning for carpet and tile floor care are
maintained.
The only specialist position we didn't make changes to was the vacuum specialist. This person uses a
backpack vacuum to complete tasks. Backpack vacuums have a greater aneuverability than canister
and upright vacuums, and increase productivity significantly.
The vacuum specialist's responsibilities include vacuuming under trash cans in each work station,
vacuuming all other traffic areas, vacuuming upholstery and repositioning furniture, turning off lights
upon completion of room and securing the area as requested. With the backpack vacuum we were
able to reach a productivity level between 8,000 to 10,000 sq. ft. per hour, depending on the service
area. We chose a backpack vacuum with a four-filter system that contains 96-99 percent of one
micron and larger dust particulate vacuumed. The type of vacuum we selected met our infection
control policy that requires that vacuums used by the environmental services department be of a type
and model that does not add airborne particles to the environment.
Conclusion
The results of our transition to Team Cleaning are noteworthy. The seven-specialist team reduced
our labor cost by 28%, while maintaining or improving the quality of cleaning. Our customized
Team Cleaning program successfully addressed all regulatory standards, while reducing worker
exposure to biohazardous waste by 70%. As a result of these findings, we believe Team Cleaning
will become the standard in healthcare facilities.
David Holsinger is Asst. Director of Environmental Services at Kaiser Permanente Medical Center, Fontana, CA
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