Best Practices for Environmental Cleaning

MODULE 5 – Additional Precautions

Learning Objectives

1. Describe and demonstrate appropriate procedures for cleaning rooms of clients/patients/residents on additional precautions.

2. Describe and demonstrate appropriate procedures for specialized cleaning.

2

What are Additional Precautions?

• Additional Precautions are necessary in addition to Routine Practices for certain pathogens or clinical presentations. These precautions are based on the method of transmission (e.g. contact, droplet, airborne). (PIDAC 2009)

3

Principles of Additional Precautions

• Additional Precautions are used in addition to Routine Practices for clients/patients/residents known or suspected to be infected or colonized with certain microorganisms to interrupt transmission.

• Additional Precautions include the use of barriers, such as PPE, and additional environmental controls that are put in place for encounters with the client/patient/resident or their immediate environment. In some instances, specialized engineering controls or enhanced cleaning protocols may be required.

4

Additional Precautions

• Additional Precautions are based on the mode of transmission

• There are three categories of Additional Precautions:

Contact Precautions

Droplet Precautions

Airborne Precautions

• The practices used in Additional Precautions may vary with the type of health-care setting

5

Elements of Additional Precautions

6

7

Learning Checkpoint

7

Learning Checkpoint

• Which of the following is a true statement about Additional Precautions?

a) Additional precautions should be used only when your supervisor informs you of these.

b) Additional precautions are used in addition to Routine Practices to care for some clients/patients/residents.

c) Additional precautions are used only by nursing staff.

d) Additional precautions are the same in all health-care settings.

8

Learning Checkpoint Answer

• The correct answer is: b – Additional precautions are always used with routine practices when you are working with some clients/patients/residents who have specific germs or symptoms that may be transmitted to other clients/patients/residents/staff and/or visitors in the health-care setting.

9

Contact Precautions

• Routine Practices plus:

PPE as indicated on signage

VRE and C. difficile require special cleaning

All high touch surfaces must be cleaned at least daily

Remove and launder all curtains when visibly soiled and on discharge/vacancy cleaning

Sample sign only

10

Contact Precautions – C. difficile environmental cleaning

• Daily cleaning – clean room twice per day

• In addition to routine cleaning:

Use a fresh bucket and mop head for each room

After cleaning, apply a sporicidal disinfectant to all surfaces and ensure sufficient contact time (if product used for cleaning is sporicidal this step is not necessary)

11

Contact Precautions – C. difficile environmental cleaning

• Discharge cleaning – double cleaning

Use when precautions are discontinued or resident/patient discharged or transferred

Remove all dirty/used items

Remove curtains

Discard all disposable supplies

Use fresh cloths, mop, supplies and solutions to clean the room for each cleaning

Ensure appropriate contact time for disinfectant

12

Contact Precautions – VRE environmental cleaning

• Daily cleaning

• In addition to routine cleaning:

Use a fresh bucket and mop head for each VRE room

If a low-level disinfectant is not used for cleaning; then apply a low-level disinfectant after cleaning to all surfaces and ensure sufficient contact time

13

Contact Precautions – VRE environmental cleaning

• Discharge cleaning:

Use when precautions are discontinued or resident/patient discharged

Remove all used/dirty items

Remove curtains

Discard all disposable supplies

Use fresh cloths, mop, supplies and solutions to clean room

Ensure appropriate contact time for the disinfectant

14

Droplet Precautions

• Routine Practices plus:

PPE as indicated on signage

Routine cleaning of patient/resident room

All high touch surfaces in the room must be cleaned at least daily

Sample sign only

15

Airborne Precautions

• Routine Practices plus:

Fit-tested N95 respirator on entry to room

Routine cleaning of patient/resident room

All high touch surfaces in the room must be cleaned at least daily

Room to be at negative pressure to other adjacent areas

Sample sign only

16

Combinations of Additional Precautions

• Some microorganisms may have more than one way of being transmitted. In these instances a combination of Additional Precautions may be used.

E.g. Respiratory viruses may be spread through droplets and indirect contact with objects in the immediate environment, therefore both Droplet and Contact Precautions are used.

17

Learning Checkpoint

18

Match the correct statement to the type of Additional Precaution

• Fit-tested N95 respirator required

• Room to be cleaned using a sporicidal agent

• Disposable supplies to be discarded during discharge clean

• PPE includes mask and eye protection

• Contact Precautions

• Airborne Precautions

• Droplet Precautions

• Contact Precautions – VRE

• Contact Precautions – C. difficile

• Droplet and Contact Precautions

19

Learning Checkpoint Answer

• Fit-tested N95 respirator required – Airborne Precautions

• Room to be cleaned using a sporicidal agent – Contact Precautions C. difficile

• Disposable supplies to be discarded during discharge clean – 2 correct answers – Contact Precautions – VRE and Contact Precautions – C. difficile

• PPE includes mask and eye protection – Droplet Precautions

20

When you return to your job, what will you do differently as a result of this session?

2121

22

Thank You!Thank You!

22

Image Sources – Module 5

• Microsoft Office Clipart used in slides 7 & 18

• Images in slides 10, 15 & 16 are © PHO 2013

23