Cleaning is often overlooked as a simple process that does not require much thought or support with respect to education, formal or informal. In many ways as the number of university or college graduates increases so does our belief that cleaning is a mundane task that takes virtually no education or expertise. This belief is fostered from a young age as we witness our parents, primarily our mothers, cleaning dishes, cleaning the house, the laundry and even us! Certainly as we mature, we are taught how to clean up after ourselves and for many your allowance may have been based on the unpleasant task of cleaning your bedroom before you were allowed to watch Saturday morning cartoons. How did we clean? We were given one cloth and whatever cleaning solution was to be used and told to go at it! Sorry mom, you were wrong…….so, so wrong…..Cleaning and the knowledge surrounding cleaning techniques that need to be used in healthcare facilities is far more complex than we give credit. Like the cleaning of surgical instruments, cleaning of environmental surfaces requires meticulous attention to detail with a well defined and ordered set of procedures. One of the most important concepts that housekeeping and nursing staff need is the knowledge that bugs can be transmitted from surface to surface. Studies have in fact shown that bugs can be transferred from surface to surface with cleaning cloths.
A very integral part of training for Housekeeping and Nursing Staff in healthcare facilities is the importance of moving from clean to dirty with the understanding that surfaces furthest away from the patient should be the cleanest while the surfaces closest to the patient are the dirtiest – just think of all the blood, mucous, pus, vomit, diarrhea that a patient can excrete! This is where the monogamous surface-wipe relationship comes to play. While the areas furthest away are the cleanest…it in no way means they are free from bugs. The area to be cleaned should be viewed as a series of zones. As an example, if cleaning a private room, consider the entry way as zone 1 – door handle, light switch etc should be cleaned with one cloth then move to zone 2 which could be the window area, visitor seating, patient closet etc and clean with a new cloth. Before going to zone 3 the hand hygiene sink &/or nurses storage area, grab a new cloth. Cleaning needs to take place in almost a circular fashion around the perimeter of the room before you move into the “Dirty Zone” – the patient space which includes the bed, over bed table etc. If there is a bathroom or commode leave it until the end and NEVER clean the toilet first! The toilet or commode is the Holy Grail when it comes to the Dirty Zone!!!
Cleaning is a tedious and laborious task and one that has far too many opportunities for cheating and taking short cuts. A nurse or doctor may be breathing down the neck of the housekeeper to speed things up and ready the room for the next patient so the concept of moving from clean to dirty can be thrown out the window and with it, the importance of changing cloths between zones. We shudder at the images that CNN and other networks have shown with undercover videos of housekeeping staff at hotels wiping glasses down with the same cloth they have used to clean the toilet. In an environment where we know that bugs exists and the economic burden of HAIs do we really want to foster a culture where taking short cuts is acceptable when we have the science to prove we can cause harm by doing so? I think not.
Make “1 surface, 1 wipe” your facility mantra!
Bugging Off!
Nicole
university hospital where my mother acquired CRE: housekeepers started cleaning in the bathroom, placed the toilet brush on the counter of the room (yes, the same counter that the nurses placed all their meds and equipment). housekeeper then cleaned the counter with the cloth that he then cleaned the rest of the room with! FYI, the toilet brush that he placed on the counter was used to clean every toilet on the floor with!
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