Housekeeping Infection Control Manual

(Designing an Infection Control Manual for Environmental Services)

by

Raymond B. Otero, Ph.D.
Consultant

1. Introduction

Nosocomial (hospital associated) infections are very seldom caused by the environment such as contaminated surfaces, equipment, air and dust. However, there have been rare incidences of its occurrence. Housekeeping practices, if performed correctly through educational presentations, will create an area suitable for patient, visitor and healthcare worker to enter and be comfortable within the confines of the environment. The proper maintenance of a health care facility increases the awareness of other employees of the necessity of good sanitary practices. Good housekeeping practices increase moral and public relations. No one wants to work in an area that smells or is dirty.

The following are points that should be included in the housekeeper's infection control manual. Expansion of each point to fit your facility is strongly recommended.

2. Responsibilities

1. Executive Housekeeper

1. Supervises all activities of housekeeping in a healthcare environment.
2. Evaluates products to be used for housekeeping practices.
3. Assists in developing seminars that pertain to housekeeping practices.
4. Acts as a consultant to the infection control/quality assurance committee.

2. Surveillance Officer (Infection Control Person)

1. Assesses with the executive housekeeper sanitation practices.
2. Presents seminars on infection control that pertain to housekeeping practices.
3. Helps in developing the infection control manual for housekeeping practices

3. Infection Control Committee Members

1. Review policies that the housekeeper has presented in a timely manner.
2. Review any changes in disinfectants that the housekeeper suggests.
3. Review data that indicate that the environment may be a source of an outbreak.

4. Chairperson of the Infection Control Committee

1. Consults with any of the above and makes suggestions.

3. Infection Control Practices

1. Introduction

Sanitation depends upon cleaning thoroughness. There should be procedures in writing to fit each area of the facility such as walls, floors, windows, beds, furniture, draperies, carpets, waste containers, bathrooms, equipment, stairs, elevators, special-care equipment and handling of infectious waste for disposal.

2. Patient rooms

1. All horizontal surfaces are cleaned daily or as needed with an EPA registered disinfectant.
2. Uncarpeted floors are cleaned daily or as needed with an EPA registered disinfectant.
3. Carpeted floors should be vacuumed daily or as needed according to manufacturer's recommendations. Procedures should be spelled out concerning disinfecting carpets that contain blood. The vacuum cleaner should be one that does not add airborne organisms to the environment. Change filters as needed.
4. Bathroom is cleaned daily or as needed. Remember that this area of the patient's room may contain high concentrations of body fluids that may neutralize the disinfectant being used.
5. Sanitary procedures are performed with common sense in mind.
6. Drapes are examined for body fluids or soiling. They do not have to be removed from isolation rooms once the patient has either recovered or been placed in a different locale unless body soils are visible. Drapes have never been implicated in cross contamination of patients.
7. Walls are only spot cleaned. There is absolutely no need in washing walls after a patient has been dismissed from a room intended for any type of isolation.
8. Normal disinfection procedures are employed in cleaning rooms used for isolation.
9. If a patient is in isolation such as airborne (formerly known as tuberculosis [AFB] isolation), then the appropriate masks (N-95) should be worn upon entering room.
10. Gowns and gloves are used accordingly.
11. All patient use items (wheelchairs, etc.) should be disinfected with an EPA registered disinfectant as needed.
12. Stainless steel double-bucket system should be used in all areas of the facility. Plastic buckets tend to become soiled and difficult to clean.
13. All waste paper baskets should be lined with a plastic bag.
14. Housekeeping personnel should report to the executive housekeepers any equipment that is not functioning correctly.
15. Make certain that all MSDS forms are up to date.

3. Other areas

1. Entrances, lobbies, waiting rooms, hallways should be cleaned on a regular schedule or as needed depending on traffic.
2. A disinfectant solutions is not really needed in these areas.
3. Clean carpets according to manufacturer's recommendations. Make certain that you have discussed with the manufacturer that if blood is spilled on these carpets, what type of chemicals can be used without damaging the fabric. Remember that you must use a tuberculocidal disinfectant on blood spills.
4. Examine walls for soilage. Spot clean any wall that contains soil.

4. Personnel

1. Personnel should be free of skin lesions such as herpes, boils, etc.
2. All employees in housekeeping should be educated on what requires work restriction due to illness.
3. All housekeeping personnel should be ideally vaccinated against tetanus, hepatitis B and influenza. The chickenpox vaccine is now available for those without prior history of exposure or immunity.
4. Rubella and measles vaccine should be part of the employee's responsibility prior to employment.

5. Regulated trash

1. All housekeeping personnel should be cognizant on what types of waste require regulation. OSHA has defined what requires regulation. However, states, city's and county's may have additional requirements. They should be listed in the procedure manual.
2. All housekeeping personnel should have inservice education on Standard Precautions (formerly Universal Precautions) on a yearly basis. Documentation of such education should be made available to any licensing agency.

4. Summation

1. Contamination of the environment is only a risk to the patient if there is a potential mode of transmission.
2. Housekeeping is responsible for selecting a disinfectant, writing procedures on how to dilute it and when it should be changed during usage.
3. Housekeeping personnel need yearly inservices on infection control practices.
4. Cleaning in wrong sequences (soiled to clean) may increase the chance of microbial contamination.
5. Use of dry-dusting increases aerosols.
6. Use of reusable rather than disposable gloves affords the housekeeper more protection.
7. Never store mops in a wet condition. This will increase proliferation of organisms. They should be dried after cleaning.
8. Always check with other areas of the hospital/nursing home tomake certain that everyone is doing their job correctly, i.e., surgery, nursery, dietary, etc.
9. Make certain that housekeepers understand how to pickup sharps from the floor, i.e., needles.
10. Housekeepers must be provided the appropriate barrier protection for their tasks, instructions on where they are located, how to take them off and where to place them after removal.
11. All filters in rooms should be checked on a regular schedule. When a filter is removed (changed) from a particular area, the date of newly installed filter should be written clearly on its side with a marking pen. This will enable the housekeeper to determine how often these filters should be changed.
12. Change curtains as needed.
13. Clean blinds as needed.
14. It is not necessary to discard toilet paper or paper towels following patient discharge regardless of the sickness unless they are visibly soiled with body fluids.
15. Always make certain that paper towel dispensers are full and that soap dispensers are functional.
16. Always check needle disposal boxes to make certain that they are not more than 3/4 full.
17. Check to make certain that all screens are functioning correctly.
18. Check schedules of waste pickup to make certain that excessive accumulation does not exist.

NOTE: Every hospital/nursing homes must have in place a written procedure on the type of methods that will be employed to protect the highly susceptible patient from aerosols created during construction projects.

 

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