Environmental Cleaning and Maintenance In

Environmental Cleaning and Maintenance in

Dental Practices Policy

Date of IssueAugust 2010

Date of ReviewAugust 2013

Document Status:Current
Developed by:Tracey Stevenson Infection Prevention and Control Facilitator
Judy Blake Specialist Infection Control Nurse
Policy Number / ID, Version 1.1
Date of Policy / August 2010
Next Review Date / August 2013
Sponsor / Dorset Community Health Services
Consultation with / Dorset Infection Control Forum
Version / Date / Comments
1.0
2.0 / 14 October 2010 / National Guidance Introduced September 2010

CONTENTS

1.POLICY STATEMENT

2.INTRODUCTION

3. LEVELS OF DECONTAMINATION

4. RISK ASSESSMENT FOR DECONTAMINATION METHODS5

5. THE ENVIRONMENT6

6CLINICALENVIRONMENT6

7.CLEANING - THE USE OF DETERGENT7

8.CLEANING EQUIPMENT8

9. TRAINING8

10.AUDIT8

11.REFERENCES AND SOURCES OF INFORMATION9

APPENDICIES

APPENDIX 1 STANDARDS OF CLEANING10

APPENDIX 2 EXAMPLE CLEANING SCHEDULE13

APPENDIX 3GUIDANCE FOR STAFF IN CLEANING DUTIES14

APPENDIX 4CARE OF CLEANING EQUIPMENT16

APPENDIX 5COLOUR CODING OF CLEANING EQUIPMENT17

APPENDIX 6METHOD OF CLEANING - TASK LISTS18

APPENDIX 7CLEANING AUDIT26

APPENDIX 8CLEANING CHECKLISTS28

1. POLICY STATEMENT

All health care premises tomaintain high standards of cleanliness, this is important for 3 reasons:

• because it is what clients expect and deserve
• It contributes to ensuring a safe environment
• because it is mandatory requirement under the Health & Social Act 2008

The public are increasingly well informed about the risks of healthcare associated infections and will be reassured if the environment is clean, uncluttered and well organised.

2.INTRODUCTION

2.1 The aim of this guidance is to ensure that safe and uniform standards of cleanlinessare maintained in all areas to minimise the risk of infection (Appendix 1). To ensure these standards are met cleaning schedules to be in place indentifying frequency and responsibility. See example Appendix 2.

2.2 Service providers need to demonstrate that they provide and maintain a clean andappropriate environment which facilitates the prevention and control of healthcareassociated infections (Criteria 2 of the 'Code of Practice for the NHS on the Prevention andControl of Healthcare Associated Infections)

2.3 High standards of cleanliness and hygiene are important for producing anenvironment which reduces the risk of infection being transmitted to patients. It is the responsibility of ALL staff to participate in ensuring a clean environment and guidance is included in Appendix 3. Equipment used in cleaning procedures to be clean and suitable for the tasks (Appendix 4) and colour coded to prevent cross contamination between areas within the practice (Appendix 5). Cleaning tasks relevant to dental practices have been taken from the cleaning manual to facilitate cleaning. (Appendix 6)

2.4 The transfer of microorganisms from environmental surfaces to patients/clients islargely considered to be via direct (hand) contact with these surfaces. As aconsequence, hand hygiene is paramount in reducing infection spread via this routeas well as the appropriate control of the environment. (refer to hand hygiene policy)

2.5 The term ‘environment’ refers to:

• Any general horizontal surfaces in the environment (low and highlevel must be considered)
• Any frequently touched surfaces in the environment. This also includes roomssuch as, store rooms, dental surgeries,reception & waiting areas
• Furniture in the environment, such as chairs, tables shelving and cupboards.
• Toilets
• Sinks, basins, showers and the items surrounding these, including, e.g.soap & paper towel dispensers
• Floors & skirting
• Windows and surrounds
• Doors, door handles particularly those in the immediate environmentfrequently touched by patients & workers
• Other paint work and surroundings, e.g. skirting, walls, partitions (particularlyfocusing on those frequently touched);

• Curtains, window blinds
• Radiators, light fittings and light switches
• Kitchen areas (specific guidance for main kitchens/food hygiene is notcontained within this policy).

This list is not exhaustive and judgements should be made in each specific setting as to how to control the environment.

3. Levels of Decontamination

3.1 Cleaning – Physically removing soil, e.g. dirt and grime, along with most pathogens using detergents (enzymatic and soap) and friction. This is the first level of decontamination and may be all that is required for certain items.

3.2 Disinfection – a process which reduces the number of viable micro-organisms but is not necessarily effective against bacterial spores or some viruses. Disinfection can be achieved through the use of heat or chemicals.

3.3 Sterilisation – means that the complete destruction of all micro-organisms, including spores (with the exception or prions). Equipment and materials which come into contact with broken skin or mucous membranes should be sterilised, e.g., instruments. Sterilisation is best effected by moist heat, usually by autoclaving under pressure.

4. Risk Assessment for Decontamination Methods

4.1 The choice of method is dependent on the nature of the object to be treated and howand on whom it is to be used. The modified Spaulding classification defines fourcategories:

Minimal Risk: Surfaces that will not come into direct contact with patients e.g. floorsand fittings.

FOR MINIMAL RISK ADEQUATE CLEANING WITH DRYING IS USUALLYREQUIRED

Low Risk: Surfaces and equipment that come into contact withintact skin e.g. dental chair.

Intermediate Risk:

*Items in contact with intact mucous membranes e.g. endoscopes.

*Items in contact with diseased/damaged skin.

*Items that are heavily contaminated with virulent or readily transmitted

pathogens or substance i.e. faeces, blood etc.

* Any items to be used on highly susceptible/immunocompromised patients.

FOR INTERMEDIATE RISK DISINFECTION IS USUALLY REQUIRED

High Risk:Equipment that enters sterile cavities or vascular systems, or is contact with a breakin the skin or mucous membrane.

FOR HIGH RISK STERILISATION IS USUALLY REQUIRED

5.The Environment

5.1Work surfaces should be impervious, sealed and easy to clean, and where possible curve up the wall. Floors should be non-slip, continual and where possible curve up the wall by at least 3 inches. Carpets should not be used in clinical and communal areas. Any joints should be welded or sealed where they are unavoidable to prevent damage.

5.2Upholstered furniture should be impermeable and wipeable.

5.3Clinical waste containers / bins should be foot operated with a lid and be easily accessible in clinical areas (refer to waste management policy)

5.4Items, such as supplies, must always be stored off the floor.

5.5Equipment purchased/used for storage, e.g. shelves, units, lockers should have easy-to-clean, smooth impervious surfaces and be water-resistant.

5.6Those items which are not intact, for example chairs, should be removed, repaired or replaced.

5.7Laminated notices should be displayed for staff & patients advising of appropriate hand hygiene guidance.

6.Clinical environment

6.1Areas within the practice need to be risk assessed in relation to the risks to staff and patients and this will enable cleaning frequencies to be established. This is included in the sample schedule in Appendix 2.

6.2 Clean and dirty areas for the surgery should be clearly identified to reduce the risk of cross contamination. Define the areas which will become contaminated during operative procedures i.e. work surfaces, dental chair, inspection light, spittoons, aspirators for example and ensure all surfaces and equipment are cleaned effectively between patients

6.3 Areas and items of equipment local to the dental chair that need to be cleaned between each patient are:-

_ Local work surfaces

_ Dental chair

_ Curing lamp

_ Inspection light and handles

_ Delivery units / dental cart

_ Spittoon

_ Aspirator

_ X-ray unit

6.4 In addition, all surfaces that have potentially become contaminated should be cleaned after each patient.

6.5 Surfaces can be effectively cleaned using commercial bactericidal cleaning agents and wipes, alcohol should be avoided as it binds to blood protein and stainless steel.

6.6 Water and suitable detergent is satisfactory provided the surface is dried after cleaning

6.7The area around the dental unit becomes contaminated by direct splatter, aerosols and by touching surfaces with gloved hands. Aerosols are generated by a wide variety of dental procedures including use of dental handpieces, 3 in 1 syringe and ultrasonic scalers. Surface cleaning prevents transmission of infection (hand hygiene also prevents transmission of surface contaminants) Avoid touching and thereby contaminating drawer handles, pens, computer keyboards and door handles with gloved hands.

6.8If patients are unwell with respiratory symptoms then they should be advised not to attend for non-urgent appointments. This risk can be reduced by the use of PPE (see personal protective equipment policy).

6.9Light and chair controls, amalgamator switches, curing light tips, and dental cart and suction tubing may be covered with impervious disposable coverings, if these are used they must be changed between patients.

6.10The patient treatment area should be cleaned after every session even if the area appears uncontaminated.

7. Cleaning-The use of Detergent

7.1 Cleaning is defined as the removal of accumulated deposits by washing with aneutral cleaning solution and with thorough drying.This is not a disinfection process, but where an alcohol wipe is used to dry surfaces,this may have a disinfecting effect.

7.2 Good quality disposable detergent wipes or neutral detergent, warm water anddisposable cloths should be used for cleaning.

7.3 Guidance produced by the Medicines and Healthcare Products Regulatory Agency(MHRA) (2002) draws on all the evidence available and recommends the use ofwater and ‘general purpose detergent’ for the cleaning of environmental surfaceswhich are only likely to be in contact with healthy skin and are therefore consideredlow risk (e.g. floors, walls, table tops).

7.4 For surfaces which become contaminated with blood and other body fluids, a disinfectant solution of 1000 ppm availablechlorine as recommended within the standard infection control precautions onmanagement of blood and body fluids (MHRA, 2002)Disinfectants should therefore not be used unless absolutely necessary.

It must be ensured that all chemicals are inaccessible to children or adults whoare confused or who have learning disabilities.

7.5 Use of Chemical Disinfectants

As microbes die rapidly on clean, dry surfaces, there is little advantage in the routineuse of chemical disinfectants, which may kill harmless germs and allow those mostlikely to cause problems to flourish without opposition. Disinfectants can have aharmful effect on the environment by damaging the surface of equipment making itdifficult to clean effectively. If there are spills or surfaces are dirty, removing the dirtby ordinary cleaning will also remove germs. Disinfectants can be harmful to those using them, especially if they are not handledcorrectly. Where possible, the use of chemical disinfectants should be eliminated.

8. Cleaning Equipment

8.1Equipment used for cleaning the environment requires to be clean, fit for purposeand in a good state of repair. Equipment to be colour coded so that it is easy to see which equipment should be used. See Appendix 4 & 5.

8.2Cleaning equipment to be stored in a designated area away from potential sources of contamination. Mops and buckets should be kept clean and dry and mops shouldbe stored head up and buckets inverted.Mop heads should be removable forfrequent laundering or single use. Carpets should not be used in clinical areas.

9. Training

9.1 It is essential that all staff carrying out cleaning duties are suitably trained and have writtentraining records that are signed and dated by the trainer and trainee.

9.2As a minimum, training must be given in the performance of cleaning tasks, the use ofcleaning equipment, control of infection, manual handling, fire, health and safety and siteorientation.

9.3Training in the performance of tasks will include the correct use of cleaning products andmaterials.Training should be consistent with the manufacturer’s instructions.

9.4 Training should be completed before new staff members are allowed to work without directsupervision.

9.5 Training should be repeated in its entirety every year or sooner if competency issuehasbeen identified.

10. Audit

10.1 Monitoring of cleaning standards should be undertaken regularly and written records kept. Electronic Samples of audit forms can be found in the National Patient Safety Agency document “The national specifications for cleanliness in the NHS: A framework for setting and measuring performance outcomes”.

A manual audit form can also be used as the example in Appendix 7

10.2 Cleaning checklists may be used to maintain records of cleaning practice, see examples in Appendix8

References and Sources of Information

.

Infection control of CJD, vCJD and other human prion diseases in healthcare and community settings 2010 [accessed 7 October 2010]

Decontamination in primary care dental facilities: policy, context and requirements manual [accessed 7 October 2010]

Personal Protective equipment guidance [accessed 7 October 2010]

National Patient Safety Agency (NPSA) - NHS Cleaning Manual

The National Specifications for Cleanliness in the NHS: A Framework for Setting and

Measuring Performance Outcomes (National Patient Safety Agency, April 2007)

DoH “Health and Social Care Act 2008; “The Code of Practice for the Prevention and

Control of Healthcare Associated Infections.”

dGuidance/DH_110288

National Patient Safety Agency, (2010) - National specifications for cleanliness: primary medical and dental premises.

DOH 2010 Uniform guidance

APPENDIX 1

Cleaning Standards for Dental Practices

Elements / Standard / Frequency / Responsibility
1 / Manual handling equipment / All parts (including wheels and castors and underneath) should be visibly clean with no blood or body substance, dust, dirt, debris or spillages / Clean contact points between patients use. + One full clean weekly / Staff using the equipment
2 / Dental Equipment / All parts (including underneath) should be visibly clean with no blood or body substance, dust, dirt, debris or spillages / Clean contact points between patients use. + One full clean daily / Staff using the equipment
3 / Medical Gas Equipment / All parts (including underneath) should be visibly clean with no blood or body substance, dust, dirt, debris or spillages / Clean contact points between patients use. + One full clean daily / Staff using the equipment
4 / Dental Chair / All parts (including underneath) should be visibly clean with no blood or body substance, dust, dirt, debris or spillages / Clean contact points between patients use. + One full clean daily / Staff using the equipment
5 / Work Surfaces / Preparation area / All areas should be visibly clean with no blood or body substance, dust, dirt, debris or spillages / Clean area between each procedure. + One full clean daily / Staff using the area between procedures
6 / Switches/sockets/data points / All wall fixtures e.g. switches/sockets/data points should be visibly clean with no blood or body substance, dust, dirt, debris or spillages / One full clean weekly / Cleaning service
7 / Walls / All wall surfaces (including skirting exposed pipes and doors) should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape or spillages / Dust weekly. + Full wash yearly / Cleaning service
8 / Ceiling / All ceiling surfaces should be visibly clean with no blood or body substance, dust, dirt, debris or spillages / Dust weekly. + Full wash yearly / Cleaning service
9 / All doors & handles / All parts of the door structure should be visibly clean so that all door surfaces, vents and jambs have no blood or body substance, dust, dirt, debris, adhesive tape or spillages / Clean handles and push plates daily. + One full clean weekly / Cleaning service
10 / All internal glazing including mirrors / All internal glazed surfaces should be visibly clean and smear free with no blood or body substance, dust, dirt, debris, adhesive tape or spillages and should have a uniform shine appearance / One full clean Monthly / Cleaning service or contractor
11 / All external glazing / All external glazed surfaces should be clean / One full clean 6 monthly / Cleaning service or contractor
Elements / Standard / Frequency / Responsibility
12 / Radiators / All parts of the radiator (including between the panels) should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape or spillages / One full clean weekly / Cleaning service
13 / Ventilation grills / extractors / Fans / The external part of the ventilation grills and all parts of fans should be visibly clean with no blood or body substance, dust, dirt, debris, cobwebs or spillages / Dust weekly + Full wash yearly / Cleaning service
14 / Floor - Hard / The complete floor (including all edge, corners and main floor spaces) should have a uniform finish and be visibly clean with no blood or body substance, dust, dirt, debris, spillages or scuff marks. / Vacuum and mop daily / Cleaning service
15 / Floor - Soft / The complete floor (including all edge, corners and main floor spaces) should have a uniform finish or shine and be visibly clean with no blood or body substance, dust, dirt, debris, spillages or scuff marks. / Vacuum daily + Full wash 6 monthly or if significantly stained. / Cleaning service for daily. Contractor for 6 monthly full wash
16 / Electrical items including phones and computer equip / The casing of any electrical item should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape or spillages. / Dust daily. Phones and keyboards cleaned with detergent wipe or equivalent daily / Staff using the equipment
17 / Cleaning equipment / Cleaning equipment should be visibly clean with no blood, or body substances, dirt, dust, debris or moisture. / Full clean after each use / Cleaning service
18 / Low surfaces / All surfaces should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape or spillages. / One full clean daily / Cleaning service
19 / High Surfaces / All surfaces (including open shelving) should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape or spillages. / Dust weekly + One full clean monthly / Cleaning service or if cluttered the staff member using the shelving
20 / Chairs / All parts of the furniture should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains or spillages. / Check daily and clean as required. +One full clean weekly / Cleaning service
21 / Tables / desks / All parts of the table/desk (including wheels/castors and underneath) should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains or spillages. / Check daily and clean as required. +One full clean weekly / Cleaning service or if cluttered the staff member using the desk/table
22 / Hand wash, Hand rub & Towel containers / All parts of the surfaces of containers should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains or spillages. Dispensers should be kept stocked / One full clean daily / Cleaning service
Elements / Standard / Frequency / Responsibility
23 / Waste bins / The waste receptacle should be visibly clean (including lid, pedal and all surfaces) with no blood or body substance, dust, dirt, debris, adhesive tape, stains or spillages. / One full clean daily / Cleaning service
24 / Curtains & Blinds / All curtains/blinds should be visibly clean with no blood or body substance, dust, dirt, debris, stains or spillages. / Change 6 monthly or if using disposable curtains refer to manufacturers guidance / Cleaning service or contractor
25 / Toys / All toys should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains or spillages. / One full clean daily or between use if contaminated or dirty. / Cleaning service or staff member
26 / Dishwasher / Dishwashers should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains, spillages or food debris. / One full clean weekly / Cleaning service or staff member
27 / Fridge / Fridges should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains, spillages, food debris or build up of ice. / One full clean weekly / Cleaning service or staff member
28 / Ice machine / water dispensers / Ice machines & water dispensers should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains or spillages. / One full clean weekly / Cleaning service or staff member
29 / Cupboards / All cupboards should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains or spillages. / One full external clean weekly + One full internal clean monthly / External clean - Cleaning service. Internal clean - Staff member
30 / Microwaves / Microwaves should be visibly clean with no blood or body substance, dust, dirt, debris, adhesive tape, stains, spillages or food debris. / One full clean daily / Cleaning service or staff member
31 / Toilet / The toilet should be visible clean with no blood or body substances, scum, dust, removable lime scale, stains, deposits or smears. / One full clean daily / Cleaning service
32 / Sinks / The sink (and such equipment as wall mounted dispensers etc.) should be visible clean with no blood or body substances, scum, dust, removable lime scale, stains, deposits or smears. Plug holes and overflows should be free from build up. / One full clean daily / Cleaning service
33 / Baby Change Areas / All parts should be visible clean with no blood or body substances, dust, dirt, debris stains or spillages. Restraints should be capable of being removed for cleaning. Cleaning materials between use should be made available. / In between patient use + one full clean daily / Service user for cleaning before and after use with available cleaning wipes. Cleaning service for daily clean

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