Hospital Infection Control Commission

April 16, 2002 updated on May 30, 2003

Routine D5

Manual
of
Cleaning
1. INTRODUCTION

2. BASIC NOTIONS OF HYGIENE AND DEFINITIONS OF NEEDS

3. DEFINITIONS AND CONCEPTS

4. NOTIONS OF HOSPITAL INFECTION

• CLASSIFICATION OF HOSPITAL AREAS

• HOSPITAL SURFACES

• TYPES OF CLEANING

• DISINFECTANT SOLUTIONS USED IN HOSPITAL CLEANING

• HOSPITAL CLEANING TECHNIQUES

5. USE OF PPE

• PRESENTATION

• USE IN DAILY LIFE

• CAUTIONS IN YOUR WORK

1. INTRODUCTION

Hygiene and order are elements that decisively contribute to the feeling of
well-being, safety, and comfort of professionals, patients, and families.
The hospital cleaning service is particularly important in the control of
Infections, by ensuring the cleaning and disinfection of hospital areas.
The appearance of infections in the hospital environment may be related to the use of
inadequate cleaning techniques, decontamination of surfaces and hospital items
improper and handling of hospital waste without adequate protection.
Due to the incorrect use of practices and work routines, it is necessary to establish.
the improvement of effective techniques for controlling and preventing hospital infections
that will generate guarantees of protection for the worker during the execution of their tasks.
Based on these principles, we created for you within the Biosafety Training
classes on the manipulation of biological material with which you will have the opportunity to acquire

new knowledge and clarify doubts about the conduct and impact of your work on
hospital environment.
This manual aims to guide on the types of cleaning and disinfection.
in this Institution.

II - HOSPITAL CLEANING SERVICE

a- Hospital cleaning staff must:

- maintain perfect personal hygiene (daily shower, clean hair, styled and tied up,
clean and trimmed nails;
- wear clean uniform;
- use personal protective equipment (PPE) when recommended;
- wash hands with water and soap after using the restroom, before eating, when starting
and finish the activities.
 a-1- Handwashing
Handwashing has always been the key point in infection control. Washing
Hand washing is the most important individual procedure in the prevention of infections.
hospital infections, 80% of hospital infections can be prevented through proper washing
the hands. It should be performed after the cleaning procedures.

Correct Hand Washing Technique:

• Turn on the tap.
• Wet your hands and apply liquid soap preferably.
• Rub your hands with soap for 15 seconds.
• Rinse your hands.
• Wipe hands with paper towel.
• Close the tap with the paper towel used in item 5.

Sample of Handwashing Technique

- remove rings, bracelets, and watches.

- wash all surfaces, the back, the palmar area, between the fingers and around the nails.
To complete: wash the forearms.
- dry with paper towel.

b- Physical Area
The cleaning service requires a specific and dedicated location for storing materials.
the equipment, this location should have a tank and be located in an easily accessible area
and with good ventilation. The size of this area depends on the needs of the hospital itself.
c- Equipment and Consumable Material
The cleaning service must have the following equipment and materials:
- brushes (prefer plastic bases);
- Rhodes
- buckets
- non-slip stairs
- panos;
- sponges;
- sanders
- paper towels;
- devices to hang brooms and mops;
- liquid soap;
- disinfectants (according to the standardization of the Hospital Infection Control Committee);

- plastic bags (10, 20, 60, 100 L) - white and black color:
- shelf with shelf;
- cabinets with a key, for storing products and/or hazardous substances (acids,
poisons, etc.) properly labeled and sealed;
- cart for transporting cleaning materials;
- cart for transporting trash
2. DEFINITIONS AND CONCEPTS

• CLEANING: It is the removal of all foreign material (dirt, organic matter)

objects or surfaces.

• DISINFECTION: Process that eliminates pathogenic microorganisms on objects

inanimate with the exception of bacterial spores.

• DECONTAMINATION: It is the process that removes pathogenic microorganisms from

objects, making it safe for handling.

• DISINFECTANT: It is an agent that destroys microorganisms, particularly

pathogenic organisms.

• INFECTION: It is the result of the penetration and multiplication of an infectious agent.

specific in the organism.

• INFECTIOUS AGENT: They are microscopic beings that are not visible to the naked eye.
bacteria, viruses, fungi, etc.

• HOST: Man or animal that offers, in natural conditions, conditions

to house an infectious agent.

• CONTAMINATION: Transfer of the infectious agent to an organism, object

or substance.

• CONTAGION: Transmission of the infectious agent from a patient or carrier to another.

individual.

• ORGANIC MATTER: They are secretions or excretions from the organism (pus, blood,
vomit, feces, urine, etc.
3. NOTIONS OF HOSPITAL INFECTION

Hospital infection is any infection acquired after the patient's admission to the hospital.

hospital and manifests during hospitalization or after discharge, when related to the
hospitalization. A hospital infection adds an average of five to ten days to the period of
hospitalization. It raises costs and is a significant cause of death during the
hospitalization. The prevention of hospital infections should be the goal of everyone
the professionals.
For a hospital infection to occur, it is necessary that there is:
• CLASSIFICATION OF HOSPITAL AREAS

Hospital areas can be classified into three categories according to their

contamination potential, thus facilitating the cleaning procedures for them
areas.

a) CRITICAL AREAS – These are the ones that pose a greater risk of infection by
risk activities developed and by the presence of seriously ill patients.

Examples :
Surgical Centers
Central of Material and Sterilization
.CTI
Dairy Farm
Laboratory
Blood Bank

b) SEMI-CRITICAL AREAS - These are areas that pose a lower risk.

contamination.
 Examples:
Infirmaries
Pharmacy
Outpatient Clinics
Cup and Kitchen
Ambulatory corridors
Elevators
Radiology

c) NON-CRITICAL AREAS - Those that, theoretically, do not present risk

of contamination.

Examples:
Administrative Areas
Library
Deposits in general
Warehouse
Changing rooms
Amphitheaters
Medical File.

• HOSPITAL SURFACES

Fixed hospital surfaces (floors, walls, ceilings, doors, furniture and

equipment) do not represent a significant risk of infection transmission in the area
hospital, making routine environmental disinfection unnecessary, unless there is
splash or deposition of organic matter, when disinfection is recommended
localized.
On fixed hospital surfaces, cleaning must be carried out whenever
present dirt using water and soap.
 ⇒ In the presence of organic matter (blood, vomit, sputum, etc.) in the sink
proceed to remove it with a paper towel, wash with water and soap, and dry it afterwards
apply the disinfectant (sodium hypochlorite), remove, clean with water and soap the remainder
dry the surfaces.

Sequential steps:

♦ Surface with the presence of organic matter,

♦ Remove organic matter with a cloth or paper, disposing of it in the waste bin.
infectant.
♦ Wash with water and soap and dry
♦ Apply the disinfectant (sodium hypochlorite)
♦ After the contact time, remove the disinfectant from the area (contact time 10 minutes)
♦ Clean the remaining area with water and soap

TYPES OF CLEANING

In the hospital, cleaning and disinfection will be carried out according to the needs of the
specific areas.

ATTENTION!! Collect the garbage before any type of cleaning. The trash cans must
they should be emptied when they reach 2/3 of their capacity. Always wash the trash cans and lids whenever

necessary.

Daily cleaning
It is the one performed daily using water, soap, and mechanical friction, after removal.
from the trash.

b- Concurrent cleaning
It is the one carried out in the facilities, during the patients' occupancy.
One must:
- remove garbage and waste in a plastic bag, collect newspapers and magazines;
- collect the dirty clothes in a plastic bag and send them to the laundry;
- dust the furniture with a damp cloth. Dry with a dry and clean cloth;
- wipe the floor with a damp cloth using water and soap, then dry with a clean, dry cloth;
- clean the bathroom;
- organize the unit.

c- Terminal cleaning

It is the one performed after patient discharge, transfer, or death. Water, soap, and
disinfectant. It includes the cleaning of horizontal and vertical surfaces and the disinfection of
furniture.
The use of disinfectant solutions is restricted to furniture, side tables, mattresses,
pools, spots, countertops, etc..., their use is unnecessary on floors, walls, and ceilings.

• DISINFECTANTS USED IN HOSPITAL CLEANING

They are chemical agents capable of destroying bacteria, fungi, and viruses in a
operational time interval, that is, at most 30 minutes.
Types of disinfectant solutions:
70% alcohol:
Ethanol has greater germicidal activity, lower cost, and lower
toxicity.
Intermediate or medium level disinfection of items and surfaces, with
exposure time of 10 minutes.
The applications should be made as follows: rub 70% alcohol.
wait to dry and repeat the application three times.
The use of acrylic is contraindicated, it hardens rubber and plastic tubes.
Indication of use:
• External surfaces of metal equipment;
• Metal parts of devices;
• Stretchers, beds, mattresses, and examination tables;
• Benches.
 b) Sodium Hypochlorite :
Medium-level disinfection of articles and surfaces.
Disinfection of any contaminated surface = 10 minutes, with 1% chlorine
active.
Its use is limited by the presence of organic matter.
The solutions should be stored in closed and dark (opaque) bottles.
Do not use on metals due to corrosiveness.

• CLEANING TECHNIQUES
The entire procedure must be carried out accompanied by the Equipment of
Specific Personal Protective Equipment (PPE) in relation to the nature of the risk to which the

the professional is exposed.

Cleaning: It is performed through mechanical friction, using water and soap.
aided by sponge, cloth, brush with the purpose of removing dirt. It should
preceding the disinfection.
Disinfection: It is carried out using Chemical and Physical Agents, and has the
purpose of eliminating microorganisms.
Cleaning Operations
1) Sweep or Vacuum
It is a hygiene operation aimed at removing dirt from the floor. In the environment
hospital, this operation should only be done with a vacuum cleaner, where there is carpet, that is, in

administration areas. The use of brooms in any other hospital area is prohibited.
it is indicated that when using a broom, microorganisms are raised along with the dust,
They can be aspirated, or they can contaminate items and equipment present in this area.

2) To wash
It is the hygiene operation aimed at the removal of debris using water and soap.
neutral. Includes the removal of loose debris, washing, rinsing, and drying.
How to proceed:
• Prepare two buckets, one with water and liquid soap and the other with clean water;
• Take the material to the area to be cleaned;
• Remove loose debris with a clean, damp cloth wrapped around a mop;
• Wet the area to be cleaned with the soap and water solution;
• Pass the washing machine on the floor, with circular movements and moving to
front and back. In the absence of such a machine, use a squeegee or broom wrapped in a cloth
for mechanical friction;
• Remove the dirty solution with the squeegee;
• Repeat the operation if necessary;
• Use a squeegee with a damp cloth soaked in clean water to rinse the floor;
• Repeat the process until the floor is clean.
• Use a dry cloth wrapped around the mop to dry the floor well;
• Clean and store the equipment.
Note: Change the water whenever necessary.

Wipe Cloth
It is the cleaning operation that aims to scrub or clean an area of the floor or furniture, with

damp cloth.
How to proceed: Two Bucket Technique
• Prepare two buckets, both with the same detergent or disinfectant solution;
• Take the material to the location to be cleaned or disinfected;
• Wet the cloth in the prepared solution and move it in straight motions forward and backward.
behind (the first time, pick up the trash that is on the ground);
• Soak the cloth in bucket number 1, which contains the solution, whenever necessary.
but dirtier, wring and dip in bucket number 2, which has a cleaner solution and wring.
If a disinfectant solution is used, just use this solution, as its use already implies in
pre-cleaning with water and soap, do not wipe with water after that; however,
If the solution is made with liquid soap, the floor should be rinsed with clean water;
wash the buckets, rinse them in the proper location, send the cloths to the laundry.
Note: Change the water with liquid soap or disinfectant whenever it is dirty.
4) To wax
It is a cleaning operation aimed at applying a layer of wax over an area. It aims to
reduce wear and dirt penetration and improve appearance.
How to proceed :
• Take the material to the area to be waxed;
• The floor should be clean and dry;
• Gather the furniture to clear the area;
• Put the necessary wax in a bucket;
• Wet the cloth and apply a thin layer with long movements and residues in one go.
direction;
• Let it dry for half an hour;
• Polish with the floor buffer;
• Save or equipment.

CLEANING FREQUENCY (GENERAL RULE)

- Daily
a- Collect the waste according to the selective collection criteria
b- Dust the furniture and accessories
c- Clean the bathrooms (including their accessories)
d- Clean the floor and walls
e- Report toilet paper, paper towels and liquid soap
f- Clean fax telephones and payphones

- Weekly
a- Wash the trash bins and dry them
b- Polish wooden furniture
c- Clean the air conditioning units
d- Clean the tiled walls
e- Clean the doors
f- Cleaning the refrigerators

- Biweekly
a- Polishing of metal accessories
b- Cleaning of glass, windows, sills, and casements
c- Cleaning of window frames
d- Clean blinds

- Monthly
a- General cleaning of walls, columns, and ceilings
b- Cleaning of lighting fixtures
c- Cleaning of roofs and gutters
 Technique for cleaning and disinfection

Floor cleaning technique

• Collect all the waste found in a white plastic bag, carefully, with
with the least possible agitation.
• Remove the trash properly bagged. Wash the trash bins and replace the bags.
plastics.
• Wet the area to be cleaned with water and soap.
• Use the floor washing machine in circular movements while moving forward.
and backward.
• Remove the dirty solution from the squeegee.
• Repeat the operation if necessary.
• Mop the floor with a damp cloth soaked in clean water to rinse it.
• Use a dry cloth wrapped around a mop to thoroughly dry the floor.
• Clean and store the equipment.
Note: In the absence of the machine, proceed to clean the floors with a cloth and mop.

2) Cleaning of walls and ceiling

• They do not need to be washed daily, but rather according to the general cleaning plan.
of the sector.
• First clean the ceiling and then the wall with movements from top to bottom.
• Always move the furniture away from the area to be cleaned to avoid damaging them; return them to the original place.
place at the end of the cleaning.

Cleaning of sinks
• Take the cleaning supplies to the sinks.
• Remove debris from the sewer opening using a hook.
• Wet a cloth and wring it out.
• Sprinkle disinfectant (sodium hypochlorite) on the surface and scrub. Washing the sink
inside and outside.
• Wash the faucets and plumbing under the sink.
• Rinse the surface and dry with a dry cloth.
• Polish the metal with a dry cloth
• Collect, clean, and store the used material.

Cleaning of toilets

• Prepare the necessary equipment: cloth, plastic brushes, buckets, soap,

disinfectants, rubber gloves.
• Fill a bucket with clean water and another with a solution of water and soap.
• Lift the seat.
• Give the download.
• Wash the exterior of the bowl, the seat on both sides, hinges and nearby parts of the
ground.
• Scrub the inside of the bowl with the brush, including the area over the rim.
• Rinse with clean water, dry the outside of the bowl, seat and
hinge.
• Give a new discharge.
• Wipe the seat and lid of the toilet with a sodium hypochlorite solution.
• Gather, clean, and store the material.

5) Cleaning of common and isolation rooms

• Notify patients and/or companions about the cleaning.
• Open the windows.
• Collect the trash, waste, and dirty clothes in a plastic bag.
• Clean the bedside table, support the IV, step stool, with a damp cloth in water and
soap. Dry with a clean, dry cloth.
• Clean the patient's bed (mattress and metal parts) with water, soap, and friction.
mechanics. Apply 70% alcohol to the mattress and to the metal parts.
• Clean the floor according to technique number 2.
• Wash trash bins and replace plastic bags.
• Clean and disinfect tables and countertops according to technique number 7.
Note: Follow the following order for cleaning: dining table, bedside table,
chair and bed.

6) Cleaning of nursing stations

• Collect scattered objects from the counter and deliver them to nursing.
• Collect garbage and waste in plastic bags.
• Remove dust from cabinets, counters, tables, chairs, countertops with a damp cloth.
water and soap. Wipe with a dry cloth and rub the medication counters with a cloth
embedded in 70% alcohol.
• Clean the floor with water and soap (floor cleaning technique number 2)
• Put plastic bags in the trash bins.
• Provide supplies in restrooms and toilets (soap, paper towels, etc.).

7) Cleaning of tables and medication preparation counters

• Wipe with a damp cloth using water and soap.

• Soak the cloth in water to rinse.
• Dry with a clean and dry cloth.
• Rub with 70% alcohol, in three applications.

8) Cleaning of examination rooms (procedures)

• Collect the garbage and waste in plastic bags.
• Clean tables, countertops, cabinets, chairs with a damp cloth in water and soap. Rinse.
with a cloth soaked in clean water. Dry with a clean, dry cloth. Rub with a cloth
embedded in 70% alcohol, in 3 applications.
• Clean the floor according to technique number 2.

9) Cleaning and disinfection of kitchen

• Collect the trash and waste in plastic bags

• Clean tables, countertops, cabinets, shelves, chairs, with a damp cloth in water and
soap. Rinse with a cloth soaked in clean water. Dry with a clean, dry cloth.
Rub with a cloth soaked in 70% alcohol, in 3 applications.
• Wash and disinfect the refrigerator with soap and water (weekly)
• Clean the floor according to technique number 2.

Cafeteria

• Cleaning with water and soap of the floor, tables, and chairs, after each meal shift.
• Cleaning of walls, ceilings, and windows once a month.

11) Air conditioning cleaning

• Remove the filters

• Wash the filters with water and soap
• Rinse with running water
• Remove the excess water and place it to dry
• Clean the device with a damp cloth.
• Put the DRY filters back in the device

12) Cleaning of telephone devices, FAX and public telephones

• Clean with a damp cloth

• Friction alcohol at 70% on all surfaces including the cables.

13) Cleaning of blinds

• Lower the blinds

• Place the blades in a horizontal position
• With a damp cloth, dust the blinds, window frame, sill and
area around the blind
• The ribbons should not get wet

14) Cleaning of Light Fixtures

• Turn off the electric current
• Remove the dust from the lamp and the light fixture with a damp cloth
• Dry the lamp and the bulb well

Frequency and Types of Cleaning and Disinfection according to sectors and units

- A- Common inpatient units

- Daily concurrent cleaning
- terminal cleaning

B- Contact Isolation Rooms (MRSA) and ICU

- Terminal cleaning
- Wipe the floor daily with a damp cloth using water, soap, and chlorine bleach.
- Wipe the wall next to the bed with a damp cloth using water, soap, and bleach.
daily
- Daily disinfection with 70% alcohol on furniture
- This area should have its own cleaning materials (bucket and cloths)

- C- Corridors
- Daily cleaning and whenever necessary on the floor
- Monthly cleaning and whenever necessary of walls and ceilings
- Biweekly cleaning and whenever necessary of windows, sills, and casement windows
- Both the hallways and the stairs should be divided into two sides: right and
left and marked with WET FLOOR signs to avoid
accidents

- D-Elevator Cleaning

- Daily cleaning and whenever necessary

- Collect all waste found in a plastic bag whenever necessary.
- Wipe the walls and floor of the elevator with a damp cloth using water and soap, daily and
whenever necessary
Dry with a dry cloth

- E- Procedure Room
Whenever necessary, after a medical consultation or examination:
- Collect the trash and waste in a plastic bag
- Disinfection of tables and countertops
- Weekly cleaning and disinfection of the refrigerator. Use 70% alcohol (rubbing 3
times), except in the erasers

At the end of each day:

- Terminal cleaning
- F- Nursing station
- Daily cleaning
- Disinfection of tables and medication preparation counters
- Monthly cleaning of walls and ceilings

M - Cleaning of the Purges

Whenever necessary:
- Remove the garbage properly bagged
- Wash trash cans and replace plastic bags
- Wash the tank with water and soap
- Clean the floor with a damp cloth with water, soap, and bleach.
- Washing floor cloths, mops, with water and soap
- Remove the gloves, wash with water and soap, rinse under running water, and dry.

N - Cleaning of the Material Preparation and Sterilization Room (CME)

- Daily cleaning
- Remove the trash properly bagged
- Wash trash cans and replace plastic bags
- Disinfection of tables and preparation benches for materials
- Wipe the floor with a damp cloth using water, soap, and bleach.
- Monthly cleaning of walls and ceilings
- This area should have its own cleaning materials (bucket and cloths)

O - Cleaning of the Material Storage Room (CME)

- Daily cleaning
- Remove the trash properly bagged
- Wash trash cans and replace plastic bags
- Disinfection of tables and preparation benches for materials
- Wipe the floor with a damp cloth using water, soap, and bleach.
- Monthly cleaning of walls and ceilings
- This area should have its own cleaning materials (bucket and cloths)

P - Cleaning of the Balconies

- Daily cleaning
- Take out the trash properly bagged
- Wash trash bins and replace plastic bags
Cleaning with water and soap and disinfection of tables, chairs, and benches

Administrative areas: healthcare professionals' rest room, managers' offices and

prescription
Daily cleaning
Care for cleaning utensils

Brushes - They should be washed with soap and water daily after use and left to dry.
with bristles down.

Buckets – They must be washed daily or disinfected. Keep them clean, dry and
forked.

Cloths – all cloths, after use, must be washed with water and soap. They must be
marked by unit and used in specific units.

NOTE: The materials used for hygiene in critical areas must be specific.
these areas and, after use, must be disinfected.

5. USE OF PERSONAL PROTECTIVE EQUIPMENT (PPE)

Cleaning service workers must use protective equipment.

individual (EPI) since their tasks require special care. these equipment
are: apron, gloves, masks, boots, and safety glasses.

Waterproof apron - use whenever there is contact with liquids and risk of
splash of organic material. After cleaning, remove the apron by pulling it from the
folds, folding them inward and rolling them inside out. After use, wash and dry the
apron

b-Long rubber gloves (non-slip) - use for cleaning and handling

of solutions. They should not be misused, such as for grabbing door handles,
phones, furniture, etc.

c-Face mask - use when there is a risk of splashing on oral, nasal mucosa, during
manipulation of disinfectant solutions and collection of dirty laundry. Must cover mouth
the nose being neglected when wet or damaged. Its use is also indicated
in respiratory isolation or total isolation areas.
d-Botas - to be worn during the entire floor cleaning and garbage collection period. They must
be waterproof and have non-slip soles. During other activities use
closed, waterproof, and durable shoes.

e-Glasses - to be used when there is a risk of splashing organic material and in dilution of
disinfectants.