CLEAN HOSPITAL

Dr. Namit Singh Tomar

Consultant QI (NHSRC)
 Introduction
• The Prime Minister launched the ‘’Swachh Bharat Abhiyan’’
on 02 Oct 2014 quoting Mahatma Gandhi that ‘Cleanliness is
next to Godliness’.
• “ MISSION SWACCH BHARAT ASPIRES TO REALIZE
GANDHIJI’S DREAM OF A CLEAN INDIA THROUGH
JAN BHAGIDARI……...TOGETHER WE CAN & WE
WILL MAKE A BIG DIFFERENCE”
WHY CLEAN HOSPITAL?

Reduce
Prevention
& Control ALS
of Hospital
Infection

Reduce
Patient
Suffering

Enhance Patient Satisfaction

 Attributes of Clean Hospital

STANDARD CLEANING IN
WHY CLEAN OVERVIEW OF
MATERIAL & HIGH RISK
HOSPITALS? CLEANLINES
EQUIPMENTS AREAS
B1 - 6 B9
B7-8
 B 1 – Cleanliness of Circulation
B 9 - Monitoring of
Area
Cleanliness Activities

B 8 – Use of Standard B 2 – Cleanliness of Wards

Methods Cleaning

B 7 – Use of standard B 3 – Cleanliness of

materials and Equipments Clean Hospital Procedure Areas
for cleaning

B 6 – Cleanliness of Toilets B 4 – Cleanliness of

Ambulatory Area (OPD,
Emergency, Lab)
B 5 – Cleanliness of
Auxiliary Areas

11/11/2023 QI NHSRC
AN APPROACH TO CLEANLINESS…
 What is 5 S?

Sort

Straightening “ORGANIZING 5S
Shine “ Cleaning Up

Standardize “Implement Best

Practices”
Sustain “Recognize
Improvements & Set high
benchmarks
 Is it only the responsibility of House
keeping Staff ?
Patients and other visitors
Healthcare workers can help by : to the health facility can
help by :

Following the
Not littering and
proper techniques
using the waste
of waste disposal
in a health facility
bins provided.

Observing Keep other areas

precautions to clean apart from
Using the
prevent focussing only on Not spitting
their area of toilets only
transmission
work
of disease
Just think where we are??

There are basically three different types of

workplaces...
 Procedure of housekeeping in
wards
The floor should be cleaned at least twice in 24
hours. Detergent and copious amounts of water
should be used during one cleaning. Lysol may be
used to mop the floor for the remaining times.
The walls should be washed with a brush, using
detergent and water once a week.

High dusting should be done with a wet mop.

Fans and lights should be clean with soap and water

once a month.
 CONTD..
All work surfaces should be disinfected by wiping with
Lysol and then clean with detergent and water twice a
day.

Cupboards, shelves, beds, lockers, IV stands, stools

and other fixtures should be clean with detergent and
water once a week.
Curtains should be changed once a month or
whenever soiled. These curtains should be sent for
regular laundering. In certain areas, e.g. Transplant
units and ICUs, more frequent changes are required.
 CONTD…
Patient’s cot should be clean every week with detergent and
water. 1% hypochlorite should be used when soiled with blood
or body fluids. In the isolation ward, cleaning is done daily.

Store rooms should be mopped once a day and high dusted

once a week.

The floor of bathrooms should be cleaned with a broom and

detergent once a day and then disinfected.
 Contd....
• Toilets should be cleaned with a brush using a detergent twice
a day (in the morning and evening). Disinfection and stain
removal solution may be used.

• Wash basins should be cleaned every morning, 2 Hourly and

whenever visible dirty.

• Regular AC maintenance is required. The AC section should

draw up a protocol for this.

• House keeping check list should be used for its monitoring.

Area Method of cleaning Frequency of cleaning Precautions
OPDs Thrice daily
Wet mopping.
Waiting areas Change the water During OPD break Gloves and
when it gets
footwear
muddied or
discoloured After the OPD is over

Gloves and
Kitchen Wet mopping Twice daily
footwear
Wards
Laboratory Wet mopping.
X-ray Change the water
Twice daily : once in the
when it gets Gloves and
evening and during OPD
Injection room muddied or footwear
break
discoloured Phenyl
can be added
Dressing room

STANDARD METHOD OF CLEANING

Area Method of cleaning Frequency of cleaning Precautions
OT To change into
Wet mopping.
Labour room the OT dress and
Change the water In the evening daily and
ICU to wear surgical
when it gets after each procedure /
NICU mask, cap,
muddied or incident
Gloves and
Minor OT discoloured
footwear
Stores and Gloves and
Dry sweeping Once daily
offices footwear
Wet mopping.
Change the water
when it gets
Toilets
muddied or Routinely Four times a
discoloured Phenyl day and whenever Gloves and
can be added required footwear
Gloves and
Gardens
Dry sweeping Once daily footwear

STANDARD METHOD OF CLEANING

 Cleaning in critical areas..
• Theatre complex should be absolutely clean at all items.
Dust should not accumulate at any region in the theatre.
• Soap solution is recommended for cleaning floors and
other surfaces. Operating rooms should cleaned daily and
the entire theatre complex is cleaned thoroughly once a
week.
Before the start of the 1st case:-
• Wipe all equipment, furniture, room lights, suction points,
OT table, surgical light reflectors, other light fittings, slabs
etc with soap solution. This should be completed at least
one hour before the start of surgery.
 Weekly Cleaning Procedure
• Remove all portable equipment.
• Damp wipe lights and other fixtures with detergent.
• Clean doors, hinges, facings, glass inserts and rinse with a cloth
moistened with detergent.
• Wipe down walls with clean cloth mop with detergent.
• Scrub floor using detergent and water or Lysol.
• Stainless steel surfaces – clean with detergent, rinse & clean with warm
water.
• Replace portable equipment: Clean wheel castors by rolling across
toweling saturated with detergent.
• Wash (clean) and dry all furniture and equipment (OT table, suction
holders, foot & sitting stools, Mayo stands, IV poles, basin stands, X-ray
view boxes, hamper stands, all tables in the room, holes to oxygen tank,
kick buckets and holder, and wall cupboards)
• After washing floors, allow disinfectant solution to remain on the floor
for 5 minutes to ensure destruction of bacteria.
 Labour Room:

House Keeping should be meticulous in labour room:-

– Clean the floor at least four times in 24hours. One of these should be with
detergent and copious amounts of water. Lysol may be used to mop the floor
for the remaining times
– Any spill of blood or fluids should be immediately decontaminated with 1%
Sodium hypochlorite 10 minutes, mopped dry and then cleaned thoroughly
with detergent and water.
– Environment and equipment should be maintained dust free.
– Strip the bed and wipe clean with detergent and water and then once more
with ecoshield after each patient. Wear gloves for this procedure.
– Use fresh linen for each patient.
Ecoshield, is a solution based on stabilised hydrogen peroxide with silver nitrate. It
has been seen to be effective against bacteria, virus, fungi, protozoa, mycobacteria,
bacteriophages and biofilms.
 PERSONAL HYGIENE
Personal cleanliness is very important part of work tidiness.
General neatness and Body odors should be prevented by Daily bath. Finger nails
cleanliness should be kept clean and short.

Hair should always be neatly combed. Women should use

hairnets to prevent hair from falling out of place during work.
Hair Women should avoid use of fancy hairstyles.

Cosmetics Makeup should be avoided. Jewelry, anklets etc. are avoided.

Uniform All staff should wear uniform as per hospital dress code.

Washing of hands with soap and water is very effective in

reducing transmission of infection and must be done
Hand wash frequently.
Care should be taken to eliminate accident / hazards. Safety
regulations should be followed to protect themselves from
risk of injury/ infection. They should wear gloves and masks
General and other PPE.
 Three Bucket Cleaning system
Three bucket cleaning system, You will need :
• Three buckets (1 - for detergent, 2 - for clean water, 3 - for emptying
used water into)
• Two mops or rags, one for clean and one for dirty
• A cleaning detergent (e.g. liquid soap)
Method:
• Place mop into detergent solution, wipe area
• Squeeze into empty bucket
• Place second mop into clean water and wipe area and squeeze into
empty bucket
• Replace water every room or every half hour whichever comes first
• Pour water down toilet
• Start at top and furthest corner from door
We need to train the staff for cleaning :
through three bucket system
 Common disinfectants used for environmental cleaning in hospitals

Disinfectants Recommended Use

Sodium hypochlorite Disinfection of material contaminated

with blood and body fluids

Bleaching powder Toilets / bathrooms - may be used in place

of liquid bleach if this is unavailable

Alcohol (70%) Isopropyl, ethyl alcohol, Smooth metal surfaces, table tops and
methylated spirit other surfaces on which bleach cannot be
used.

Detergent with enzyme Cleaning endoscopes, surgical

instruments before disinfection is
essential
Manual
 Challenges???
[Link] of Human resources
[Link]
[Link] and competency of Staff
[Link] deployment
[Link] supply of consumable
[Link] design of facility
[Link] water supply
[Link] TOR in case of Outsource
Quality implementation for cleanliness
 Allocate your resources based on risk..
• Non-critical (low risk)
– Exterior maintenance
– Administration Areas, store, records, etc.
– Patient registration and waiting areas

• Semi-critical (medium risk)

– OPD
– Clinics
– Rehabilitation - physical therapy
• Critical (high risk)
– Emergency
– Labor and Delivery
– OT& CSSD/TSU
– ICU/SNCU/NBSU
– Mortuary
Bio Medical waste Management
 Steps for Waste Management

Segregation

Collection & Storage

Transportation

Treatment & Disposal

Segregation
Collection & Storage
Transportation
Bio Medical waste storage facility
Treatment & Disposal
Management of Liquid waste
Challenges in Bio Medical Waste Management

1. Shortage of Bio Medical Waste Management Supplies

( Colour Coded Bags/Colour Coded Drums)
2. Shortage of Personal Protective Equipment's while
handling Waste
3. Unawareness of staff on segregation of waste
4. Mixing of Infectious waste with the general one
5. Irregular collection of bio medical waste from the
generation sites
6. Improper record management
7. Display of work instruction
8. No SOP
FACILITY UPKEEP AND MAINTENANCE

• The Exteriors as well as the interior of the

facility should be maintained.
• The Hospital design should incorporates
interior landscaping and views of gardens,
providing benefits to patients, caretakers
and visitors.
• The staff should be aware of the
condemnation process in the facility.
• Regular steps need to be taken for pest
/rodent and animal control in the facility.
There should be defined time frames to
carry out this activity.
 Temperature & Ventilation control
Recommended temperatures for specific areas
in hospitals

Hospital Area Temperature ºC Humidity

Operation 17-27 45-55%
Theatre
Recovery Room 24-26 45-55%
Patient Room 24-26 45-55%
Source-National Building Code (National Building Code, 2005)
 B1–B6
• B1.1 No dirt/Grease/Stains in the Circulation
area
• B1.2 No Cobwebs/Bird Nest/ dust on walls
and roofs of corridors
• B1.3 Corridors are cleaned at least twice in
the day with wet mop
• B1.4 Corridors are rigorously cleaned with
scrubbing/ flooding once in a month
• B1.5 Surfaces are conducive of effective
cleaning
CIRCULATION AREA TWICE A DAY B1

WARDS THRICE A DAY B2

PROCEDURE AREAS TWICE DAILY / B3

– OT/LR AFTER EVERY
SURGERY
AMBULATORY THRICE A DAY B4
AREAS
AUXILIARY AREAS TWICE A DAY B5
“NEVER DOUBT THAT A SMALL GROUP
OF THOUGHTFUL COMMITTED
CITIZENS CAN CHANGE THE WORLD.
IN FACT, IT’S THE ONLY THING THAT
EVER HAS.”

Margaret Mead
THANK YOU