nurses and cleaning

7/31/2019 Nurses and Cleaning

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Contamina(onandinfec(on MRSA

Survives very well in the environment

Surfaces/equipment readily become contaminated (up to 60%) Hands/gloves of HCWs become contaminated even when not

touching patients Outbreaks halted once enhanced cleaning introduced

Prior room occupancy with MRSA is a risk for acquisition

C. difficile Convincing evidence of the role of the contaminated environment

Survives very well in the environment Hand contamination linked to level of environmental contamination

Risk increases if housed in the same room as a previous positivepatient

Improved room decontamination reduces infection risks



Whoisreallycaringforyour

environmentofcare?Dumigan,Boyce2010)AJIC

We have procedures for cleaning patient care

environments, but there is often confusion about the

division of labour when it comes to cleaningresponsibilities

Systems to monitor cleaning effectiveness are

frequently suboptimal

Implemented ATP BUT – looked at ‘housekeeping’

items only

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Cleanlinessofportablemedical

equipmentdisinfectedbynursingstaff Havilletal2011)AJIC

Follow-on from previous study

ATP and aerobic cultures to assess the cleanlinessof portable medical equipment disinfected by nurses

between each patient use

equipment was not being disinfected as per protocol

Education and feedback to nursing are warranted toimprove disinfection of medical equipment

Did not test this, unlike the previous paper

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UV-visiblemarkershowingfailureof

terminalcleaningin23acutehospitals

Defined high risk objects in patient isolation rooms

marked with UV-M prior to cleaning Overall, half of objects/surfaces were not cleaned

Wide variation in cleaning particular items

Poor were toilet handles, bedpan cleaners, light

switches and door handles

Carling PC et al . Identifying opportunities to enhances environmental cleaning in 23 acute care hospitals.Infect Control Hosp Epidemiol (2008) 29:1-7



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WouldNurseshaveknowledgeof

studiesaboutwipes?? Swiping plastic surfaces with any type of moist wipe

decreases the bacterial burden

when surfaces are swiped 3 or more times, adetergent wipe is just as effective as disinfectant wipes

if a health care worker cleans a plastic object only

once, then a disinfectant wipe should be used

Berendt et al, AJIC 2011 Using the same wipe means that micro-organisms

accumulate

Cheng et al, AJIC 2011

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Cleanlinessauditofclinicalsurfaces

andequipment:whocleanswhat?Andersonetal,JHI2011

Clinical equipment frequently demonstrates high

levels of organic soil, whether or not items have

assigned cleaning responsibility

84% ‘failed’ the ATP standard used to assess

92% with no cleaning spec failed

Avg RLU indicated surfaces cleaned by professionalcleaning staff were 64% lower than those by other

staff (P=0.019)

Education is key and cleaning practices for clinical

equipment require review



Who’sResponsible?PtakandTostenson2009)Outpa(entsurgery.net

When assigning cleaning duties to different staff

members, avoid using general categories

Nurses in charge of "equipment" and housekeeping incharge of "furnishings" can cause confusion

Created a simple pictorial cleaning manual

Each page displays

a photo of an item

who is responsible for cleaning it

instructions on how to clean the item

how often to do so

Staff involved in drafting and agree responsibilities 11



Finalpoints DoN resistant to training nurses in cleaning

Lack of acceptance that this is a regular occurrence

Bed pressures, spillage etc etc

Research opportunities

Nurses knowledge and attitudes to cleaning

Impact of education and training on nurses ability to

clean How often are nurses required to undertake

‘housekeeping’ cleaning

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nurses and cleaning

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