Ritual alert: Drop routine cultures, fogging, tacky mats
Ritual alert: Drop routine cultures, fogging, tacky mats
New Centers for Disease Control and Prevention guidelines on infection control and the health care environment put the sword to a few rituals and include important new guidance on environmental services and culturing.1 Infection control professionals are urged to consult the full document for all the recommendations, but the environmental services section is summarized as follows:
Environmental Services
3-1 Cleaning and Disinfecting Strategies for Environmental Surfaces in Patient-Care Areas
3-1.1 Do not use high-level disinfectants/liquid chemical sterilants on noncritical surfaces for disinfection. Category IC
3-1.2 Follow manufacturers’ instructions for cleaning and maintaining noncritical medical equipment. Category II
3-1.3 In the absence of manufacturers’ cleaning instructions, follow these procedures:
3-1.3.a Depending on the nature of the surface and the degree of contamination, clean noncritical medical equipment surfaces with a detergent/disinfectant or soap and water, followed with an application of low- to intermediate-level chemical germicide at proper use dilution and for the full contact time required. Category II
3-1.3.b Do not use alcohol to disinfect large surfaces. Category II
3-1.3.c Use barrier protective coverings as appropriate for noncritical surfaces that are: 1) touched frequently with gloved hands during the delivery of patient care; 2) likely to become contaminated with blood or body substances; or 3) difficult to clean. Category II
3-1.4 Keep housekeeping surfaces (e.g., floors, walls, tabletops) visibly clean on a regular basis and as spills occur. Category II
3-1.4.a Use a one-step process and water/detergent or an EPA-registered hospital grade disinfectant/ detergent designed for general housekeeping purposes. Category II
3-1.4.b Follow manufacturers’ instructions for proper use of cleaning/disinfecting products, paying close attention to specified use dilutions and stated contact times. Category II
3-1.4.c Clean and disinfect high-touch surfaces (e.g., doorknobs, bedrails, light switches, surfaces in and around toilets in patients’ rooms) on a more frequent schedule compared to that for minimal touch housekeeping surfaces. Category II
3-1.4.d Clean walls, blinds, and window curtains in patient-care areas when they are visibly dusty or soiled. Category II
3-1.5 Do not do disinfectant fogging for routine purposes in patient-care areas. Category IB
3-1.6 Avoid large-surface cleaning methods that produce mists or aerosols or disperse dust in patient-care areas. Category IB
3-1.7 Follow proper procedures for effective use of mops, cloths, and solutions: Category II
3-1.7.a Prepare cleaning solutions daily or as needed, and replace with fresh solution frequently according to facility policies and procedures. Category II
3-1.7.b Use clean mops and cloths every time a bucket of cleaning solution is emptied and replenished with clean, fresh solution. Category II
3-1.7.c Clean mops and cloths after use and allow to dry before reuse, or, use single-use, disposable mop heads and cloths. Category II
3-1.8 After the last surgical procedure of the day or night, wet vacuum or mop the operating room floors with a single-use mop and an EPA-registered hospital disinfectant. Category IB
3-1.9 Do not use tacky mats at the entrance to operating rooms or infection-control suites. Category IB
3-1.10 Use proper dusting methods for patient-care areas designated for immunosuppressed patients: Category IB
3-1.10.a Wet-dust horizontal surfaces daily using cloths moistened with an EPA-registered hospital disinfectant. Category IB
3-1.10.b Avoid dusting methods that disperse dust (i.e., feather dusting). Category IB
3-1.11 Keep vacuums in good repair, and equip vacuums with HEPA filters for use in high-risk patient-care areas. Category IB
3-1.12 Close the doors of immunocompromised patients’ rooms when vacuuming corridor floors to minimize exposure to airborne dust. Category IB
3-1.13 Take precautions when using phenolic disinfectants in neonatal units. Category IB
3-1.13.a Prepare solutions to correct concentrations in accordance with manufacturers’ use instructions, or use pre-mixed formulations. Category IB
3-1.13.b Do not use phenolics to disinfect bassinets or incubators during an infant’s stay. Category IB
3-1.13.c Rinse phenolic-treated surfaces with water. Category IB
3-2 Cleaning Spills of Blood and Body Substances
3-2.1 Promptly clean and decontaminate spills of blood or other potentially infectious materials. Category IC (OSHA)
3-2.2 Follow proper procedures for site decontamination of spills of blood or blood-containing body fluids. Category IC
3-2.2.a Use protective gloves and other personal protective equipment appropriate for this task. Category IC (OSHA)
3-2.2.b If the spill contains large amounts of blood or body fluids, clean the visible matter with disposable absorbent material, and discard the used cleaning materials in appropriate, labeled containment. Category IC (OSHA)
3-2.2.c Swab the area with a disposable cloth moderately wetted with disinfectant, and allow the surface to dry. Category IC (OSHA)
3-2.3 Use intermediate-level germicides (germicides registered by the EPA for use as hospital disinfectants and labeled tuberculocidal) at recommended dilution and full contact time to decontaminate spills of blood and other body fluids. Category IC (OSHA)
3-2.4 Use a one-step cleaning/disinfecting procedure for small spills. Category II
3-2.5 If sodium hypochlorite solutions (e.g., household chlorine bleach) are selected for use:
3-2.5.a Use a 1:100 dilution (500 ppm available chlorine) to decontaminate nonporous surfaces after cleaning a spill of either blood or body fluids in patient-care settings. Category IB
3-2.5.b If a spill involves large amounts of blood or body fluids, or if a blood or culture spill occurs in the laboratory, use a 1:10 dilution (5,000 ppm available chlorine) for the first application of germicide before cleaning. Category IB
3-3 Carpeting and Cloth Furnishings
3-3.1 Vacuum carpeting in public areas of healthcare facilities and in general patient-care areas regularly with well-maintained equipment designed to minimize dust dispersion. Category II
3-3.2 Perform a thorough, deep cleaning of carpeting periodically as determined by facility policy using a method that minimizes the production of aerosols and leaves little or no residue. Category II
3-3.3 Avoid the use of carpeting in high-traffic zones in patient-care areas or where spills are likely (e.g., burn therapy units, operating rooms, laboratories, intensive care units). Category II
3-3.4 Follow proper procedures for managing spills on carpeting: Category II
3-3.4.a Spot-clean blood or body substance spills promptly. Category IC (OSHA)
3-3.4.b If a spill occurs on carpet tiles, replace any tiles contaminated by blood and body fluids or body substances. Category IC (OSHA)
3-3.4.c Thoroughly dry or replace wet carpeting within 72 hours to prevent the growth of fungi. Category IB
3-3.5 No recommendation on the routine use of fungicidal or bactericidal treatments for carpeting in public areas of a healthcare facility or in general patient-care areas. Unresolved issue
3-3.6 Avoid the use of carpeting in hallways and patient rooms in areas housing immunosuppressed patients Category IB
3-3.7 Avoid the use of upholstered furniture and furnishings in high-risk patient-care areas and in areas with increased potential for body substance contamination (e.g., pediatrics units). Category II
3-3.8 No recommendation on the use of upholstered furniture and furnishings in general patient-care areas. Unresolved issue
Environmental Sampling
4-1 General Recommendations
4-1.1 Do not conduct random, undirected microbiologic sampling of air, water, and environmental surfaces in health care facilities. Category IB
4-1.2 When indicated, conduct microbiologic sampling as part of an epidemiologic investigation. Category IB
4-1.3 Limit microbiologic sampling for quality assurance purposes to: 1) biological monitoring of sterilization processes; 2) monthly cultures of water and dialysate in hemodialysis units; and 3) short-term evaluation of the impact of infection control measures or changes in infection control protocols. Category IB
Reference
1. Healthcare Infection Control Practices Advisory Committee (HICPAC). Draft Guideline for Environmental Infection Control in Healthcare Facilities. Atlanta: Centers for Disease Control and Prevention; 2001. Web site: http://www.cdc.gov/ncidod/hip/enviro/env_guide_draft.pdf.