Sentara Healthcare defines cleaning processes step-by-step

A systemwide summit created by officials at Sentara Healthcare, Norfolk, Va., engaged environmental services managers, infection prevention and control representatives, and nursing leaders to explore ways to improve cleaning and disinfection practices and decrease process variation. 

Achieving consistent ES operations

In addition to policies on cubical curtains, the summit updated policies on cleaning occupied isolation rooms and discharged patient rooms.

Cleaning an occupied isolation patient room contains 23 steps and supplemental guidance sequenced under the major steps of “Before entering the room,” “Enter the room,” “Clean the patient bed,” “Move clockwise from the door and sanitize all surfaces and equipment in the room,” “Patient’s bathroom” and “Mop room and prepare to exit.” Supplemental guidance includes everything from washing hands to donning personal protective equipment to sanitizing the sink. 

Likewise, cleaning a discharged patient room has 28 steps and supplemental guidance under the major steps of “Before entering the room,” “Enter the room,” “Perform high dusting with an extending duster,” “Clean the patient bed,” “Move clockwise from the door and sanitize all surfaces and equipment,” “Patient’s bathroom,” “Mop and prepare to exit” and “Restock room.” Supplemental guidance includes everything from placing “wet floor” signs to cleaning the mattress.

Here is the complete list of steps and supplemental guidance:

Checklist for occupied Isolation room cleaning protocol

Note:

• Gather items to go in the room to prevent having to go back out to the cart
• Disposable bleach wipes only, change bleach wipes often to ensure saturation, no microfiber cloths

Step 1. Before entering the room:

• Check the door to validate isolation sign is present
• Place wet floor sign in front of the door
• Leave pager on cart outside of the room
• Wash hands
• Don personal protective equipment (PPE)

Step 2. Enter the room:

• Greet the patients and ask if now is a good time to clean
• Collect trash and place in garbage bag
• Wipe down exterior of the trash can

Step 3. Clean the patient bed:

• Raise and wipe down arm/hand rails (high-touch area)
• Wipe bed frame nurse call controller and phone (high-touch area)

Step 4. Room (move clockwise from the door and sanitize all surfaces and equipment):

• Door handles (high-touch area)
• Nurse responder (touchpad on wall), if applicable (high-touch area)
• Light switch (high-touch area)
• Patient-room sink, including faucet handles and countertops
• In-room soap dispenser
• Paper towel dispenser
• Glove boxes
• Overbed tray table (high-touch area)
• Bedside table (high-touch area)
• Patients chair arms and seat (high-touch area)
• Other furniture
• Window sills and ledges
• Soiled hamper lid
• Computer keyboard and scanner (high-touch area)
• Medical equipment, such as pumps (external surfaces) and IV poles (pole and base)
• Bedside commode frame and seat cover last (if in the room)

Step 5. Patient’s bathroom:

• Turn on shower to run hot water for X time
• Clean mirror with glass cleaner
• Light switch (high-touch area)
• Door handles, both outer and inner (high-touch area)
• Sink and faucet handles
• Hand rails at toilet and shower (high-touch area)
• Soap dispenser
• Paper towel dispenser
• Commode frame and seat cover
• Toilet flush handle (high-touch area)
• Toilet seat, top and bottom (high-touch area)
• Toilet paper dispenser (high-touch area)
• Toilet rim and under the bowl
• Spray bowl with commercial bleach and clean inside of toilet with a disposable toilet mop
• Mop bathroom floor

Step 6. Mop room and prepare to exit:

• Mop patient’s room with neutral cleaner
• Wipe all cleaning equipment, mop handle and spray bottle with bleach wipes
• Change gloves and return items to the cart (do not go in hall in PPE; reach cart from inside the room)
• Ask the patient, “Is there anything I can do for you before I leave?”
• Remove PPE
• Wash hands with soap and wash
• Remove wet floor sign after floor is dry

Checklist for all discharge room cleaning protocol

Note:

• Gather items to go in the room to prevent having to go back out to the cart
• Disposable bleach wipes only, change bleach wipes often to ensure saturation, no microfiber cloths

Step 1. Before entering the room:

• Change room status to “in-progress”
• Place wet floor sign in front of the door
• Leave pager on cart outside the room
• Wash hands
• Don personal protective equipment (PPE) if needed

Step 2. Enter the room:

• Remove all soiled linen from the room, remove linen one piece at a time and place in the hamper.
• Discard open facial tissue boxes and used toilet
• Empty trash container
• For isolation patients, remove curtains: replace disposable ones and hang new washable ones

Step 3. Perform high dusting with an extending duster include but not limited to (wrap the disposable duster around the microfiber sleeve and toss the duster after use):

• Television, clock, blinds, vents and area where ceiling meets the walls, ledges and curtain tracks

Step 4. Clean the patient bed (use bleach wipes):

• Raise and wipe down arm and hand rails (high-touch area)
• Wipe bed frame nurse call controller and phone (high-touch area)
• Mattress (top and bottom)
• Pillows (both sides)
• Foot and headboard
• Exposed frame, springs and bed panels
• Base of bed and wheels

Step 5. Room (move clockwise from the door and sanitize all surfaces and equipment):

• Door handles (high-touch area)
• Door
• Nurse responder (touchpad on wall), if applicable (high-touch area)
• Light switch (high-touch area)
• Patient room sink, including faucet handles  and countertops
• In-room soap dispenser
• Paper towel dispenser
• Glove boxes
• Dry-erase maker/board
• Overbed tray table (high-touch area)
• Bedside table (high-touch area)
• Patient storage cabinet and drawers
• Patients chair arms and seat (high-touch area)
• Headwall and connected equipment (oxygen and suction)
• Wipe off monitor leads
• Other furniture
• Window sills and ledges
• Soiled hamper lid
• Computer keyboard and scanner (high-touch area)
• Medical equipment, such as pumps (external surfaces) and IV poles (pole and base)
• Bedside commode frame and seat cover last (if in the room)
• Spot-clean walls
• Check cubicle curtain for stains or tears change, if needed
• Spray curtain with 3 percent hydrogen peroxide disinfection solution on contact areas of privacy curtain

Step 6. Patient’s bathroom (use bleach wipes/bleach spray and mop for toilet):

• Clean mirror with glass cleaner
• Light switch (high-touch area)
• Door handles both outer and inner (high-touch area)
• Sink and faucet handles
• Hand rails at toilet and shower (high-touch area)
• Check shower curtain and change if needed
• Wipe down the shower curtain
• Wipe off shelves
• Spot-clean walls
• Towel rack
• Emergency pull cord
• Soap dispenser
• Paper towel dispenser
• Commode frame and seat cover
• Toilet flush handle (high-touch area)
• Toilet seat, top and bottom (high-touch area)
• Toilet paper dispenser (high-touch area)
• Toilet rim and under the bowl
• Spray bowl with commercial bleach and clean inside of toilet with a disposable toilet bowl brush
• Sweep bathroom floor
• Mop bathroom floor

Step 7. Mop room and prepare to exit:

• Mop room with neutral cleaner
• Wipe all cleaning equipment, mop handle and spray bottle with bleach wipes
• Change gloves and return items to the cart (do not go in hall in PPE; reach cart from inside the room)
• Remove PPE if required
• Wash hands with soap and wash
• Remove wet floor sign after floor is dry

Step 8. Restock room:

• Replace toilet paper
• Make up the bed
• Change room status to ready

Joani Brough, R.N., NE-BC, is vice president and nurse executive at Sentara Princess Anne Hospital in Virginia Beach, Va. She can be contacted at jsbrough@sentara.com. Brough was assisted by Sentara’s Susan A. Tweed, Ph.D, R.N., research nurse scientist; Beth Ruello, RN-BC, advanced nurse education specialist; and Diane M. Peters, MT(ASCP), CPLP, instructional design consultant.