Cleaners Social Care by Karen Foulis

Environmental Cleaning Policies & Procedures Manual Including Infection Control for housekeeping staff Social Care

Infection Control Cleaning Management Gordon House, Station Road, Mill Hill, London NW7 2JU Telephone: 020 8906 2777

i www.infectioncontrolcleaning.co.uk

ISO 9001 REGISTERED FIRM

INTERNATIONAL ACCREDITATION BOARD

Certificate No. GB2001573

Registration No. 0044/1

Infection Control Cleaning Management

Contents General

1 2 3 4 5 6 7 8 9 10

Introduction Aims Legal Framework Roles and Responsibilities Risk assessment Clothing and Jewellery Safe Manual Handling Health and Safety Record Keeping Training

Section 2

Cleaning Equipment and Chemicals

1 2 3 4 5 6 7 Appendix 1 Appendix 2

Storage Colour Code for Hygiene Cleaning Equipment Microfibre Cleaning Chemical Hazards Table of Types of Cleaning Chemicals Safety Precautions Common detergents, combined agents and disinfectants used in healthcare. Sample Risk Assessment

Section 3

Infection Prevention & Control

1 2 2.1 2.2 2.3 2.4 2.5 2.6 Appendix 1 Appendix 2 Appendix 3

Chain of Infection Infection Prevention and Control Principles Environment Hand Decontamination Personal Protective Equipment Waste Management Accidental exposure to blood/body substances Blood/Body fluid spillage management Hand Decontamination Technique Colour Coded Waste Segregation Action following needlestick / sharps / splash injury

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Section 1

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Contents Infection Prevention Solutions ÂŠ2014 Page 1 of 11

Infection Control Cleaning Management

Cleaning Specification

Section 5

Cleaning Schedules

Section 6

Method Statements

Section 7

Auditing and Monitoring

Section 8

Glossary

Section 9

References

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Section 4

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Infection Control Cleaning Management

Section 2: Cleaning equipment and chemicals 1. Storage

2. Colour code for hygiene

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All cleaning cupboards and storage areas should be fit for purpose, well maintained and locked at all times (COSHH 2002, Health and Social Care Act 2008). The safety data sheets provide specific advice on storage, handling and disposal requirements for each chemical. It is important that these are followed to ensure the safety of the user and others, and also to prevent any possible damage to the environment.

The National Colour Coding (NHSE 2007) for hospital cleaning materials and equipment was issued as a standard colour code for cleaning services in the NHS, to ensure that items such as cloths, mop heads, buckets and gloves are not used in multiple areas, therefore reducing the risk of crossinfection. It is recommended that all practices adopt the coding scheme as below and it is vital that this forms part of the employee induction and continuous training programme. A minority of people are colour-blind in one or more colour and are unaware, it is therefore recommended that a colour identification test is conducted at induction to detect any colour blindness.

Red

Sanitary areas including sinks in sanitary areas

Blue

General areas, e.g. waiting rooms and consulting rooms (including sinks in general areas)

Green

Yellow

Kitchens

Treatment and minor operation rooms

3. Cleaning equipment

All cleaning equipment should be maintained and in good working order to avoid accidents, and kept clean and hygienic to eliminate the risk of cross infection. To avoid accidents equipment should always be cleaned and stored safely when finished with. The following list of equipment which is not exhaustive is required for cleaning with chemicals:  

Personal protective equipment COSHH safety data sheet

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Infection Control Cleaning Management

     

Colour Coded Cloth – disposable / microfibre Colour Coded Mops – disposable / microfibre / reusable Colour Coded Mop handle Colour Coded Bucket Colour Coded Bowl Chemicals as per dilution rate

4. Mircrofibre

5. Cleaning chemical hazards

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Microfibre mops and cloths are made of composite synthetic fibres which are extremely fine, and which are engineered to have a large surface area. This provides a greater effective cleaning capacity and the small size of the microfibres enables them to reach into microscopic crevices in surfaces, and are also naturally statically charged. This combination enables them to remove a greater number of contamination particles than conventional mops and cloths. They are designed to be used as part of a well-coordinated and tightly control cleaning system (NPSA 2009).

Chemicals are relatively safe to use if used in accordance with the manufacturer’s recommendations and containers of hazardous chemicals must provide warning labels. Other chemical containers should provide warning labels, with basic information and directions including; first aid instructions explaining what to do in the event of inhalation or contact with skin or eyes. In addition to the relevant precautionary information, there should be information on Personal Protective Equipment (PPE) requirement, disposal of any chemical residue or used PPE, handling and storage and what actions to take following spillage or fire. The hazards presented by chemicals fall into four broad groups:    

Corrosive: Explosive: Irritant: Toxin:

causing chemical burns causing burns or fire causing allergic reaction causing poisoning

Risk assessments should be undertaken for chemicals used. A sample risk assessment is included at appendix 2. 6. Types of cleaning chemicals

The COSHH safety data sheets for each chemical used in the premises must be readily accessible for all staff. Those that handle, dilute, use, store or dispose of detergents and disinfectants must do so in accordance with the manufacturer’s instructions. When selecting a cleaning agent (detergent, disinfectant or dual purpose cleaner/disinfectant) for a cleaning task the following should be considered: -whether the cleaning agent is approved for use in that particular circumstance -effectiveness of the cleaning agent against particular microorganism – log reduction/contact time -suitability of the product, practical application of the product -the intended purpose of the product as per the manufacturer’s instructions -available resources, including required training

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Infection Control Cleaning Management

General cleaning involves the removal of dust and dirt and cleaning chemicals, which are safe and effective, are used to achieve this aim in both clinical and non-clinical areas. There are a variety of cleaning chemical available including detergents, disinfectant, bathroom/toilet cleaners and other forms of chemicals for specific tasks. 

Detergent: cleaning agent that helps to remove dirt and grease from porous and non-porous surfaces. Soap-less or synthetic detergents are manufactured from organic chemicals usually derived from petroleum:

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-can be acidic, neutral or alkaline. For most general cleaning tasks neutral detergent solution, pH between 6-8 should be used -commonly used detergents include bathroom/toilet cleaners, crème cleansers, bathroom cleaning solutions, toilet bowl cleaners, disposable detergent wipes, carpet shampoos/cleaners, floor cleaners, descaling chemicals (lime-scale). This technology works through the use of a surfactant which does not inhibit the release of chlorine; this allows the detergent effect to coexist in a solution. The detergent effect removes organic and oily soiling into the solution, while the chlorine kills microorganisms by oxidisation Dual purpose hypochlorite cleaner/disinfectants: number of products now exist which combine a detergent cleaning effect with a disinfecting biocide. They are designed to eliminate the need for separate cleaning disinfection processes by combining them into a single process. Frequently used for a short defined period i.e. during an outbreak, extreme risk areas, or frequently touched surfaces and items



Dual purpose chlorine dioxide-based cleaner/disinfectants: serve the same purpose as the hypochlorite cleaner/disinfectants, but it uses a different chemical technology, which is not used widely at present within the UK.



Disinfectant: the effectiveness of any chemical disinfectants is strongly dependent on their condition of use. In order to be effective, they must be used in accordance with the manufacturer’s instructions, at the appropriate strength and for the contact time specified. Solutions made from tablets should be freshly prepared. The main types of disinfectants are Alcohol, Chlorine and chlorine compounds, Hydrogen Peroxide, Phenolic and Quarternary ammonium compounds



The following tables at appendix 1 outline the types of common cleaning chemicals.

7. Safety precautions

All equipment should be used in accordance with the manufacturer’s instructions. All electrical equipment must be inspected regularly by a qualified person and possess an up to date PAT certificate/label. Equipment must not be left unattended, especially if connected to the power supply and switched on. Appropriate warning signs and barriers must be installed to maximise public safety by advising staff and the public of the potential hazard(s) during the cleaning process. Staff must not attempt to remove any part of the machine whilst it is connected to a power supply and in motion, always switch off and unplug before attempting any work on machine. Any defected equipment must be reported to manager immediately and taken out of service and labelled thus until it is either repaired or replaced.

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Type of detergent Anionic

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Appendix 1 - Common detergents, combined agents and disinfectants used in healthcare.

Referred to as ‘neutral’ detergent Use soap-less detergent

Available as liquid and powder Manufactured from strong alkalis and weak acids Effectiveness is even combined with a non-ionic detergent

when

-Do not ionize or carry a charge when dissolved in water -Manufactured from alkalis and acids of equal strengths and are, neither alkaline nor acid. They have a pH value of 7 Compatible with many ingredients, included in a wide variety of formulations -Acts as a foam booster when combined with other detergents such as anionic detergents Carry a positive charge when dissolved in water

Disadvantages

-Safe for use on all floors and should not affect any pigment present in the floor covering -Can safely be used on waxed or un-waxed floors or floors treated with a water emulsion floor wax or solvent based wax -Can be used in conjunction with mopping equipment or a polishing/scrubbing machine -More effective than non-ionic detergents in the wetting of metal surfaces -Very effective in removing inorganic dirt and soil -Greater dirt carrying capacity than nonionic detergents Fairly inexpensive Safe for use on all surfaces Produce less foam than anionic detergents May be effectively used in conjunction with scrubbing machines or other cleaning equipment Easy to rinse Effective for use in hard water Effective for removing oils and grease

Not very effective in hard water

-Low foam characteristics -Carry anti-static properties -Effective in repelling dust

-Expensive -Used alone, are very ineffective -Usually combined with non-ionic

EX A

Non-ionic

greater

Advantages

Cationic

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More difficult to rinse than non-ionic detergents Produces considerable amount of foam

Less effective than anionic detergents in wetting of metal surfaces Available in liquid form

Infection Control Cleaning Management

-Positive charge carried by dust in the atmosphere -Effective as bactericide, disinfectant and deodoriser

Acidic in nature with a pH value < than 7

Also referred to as ampholitic detergents Have both acidic and alkaline properties Mainly used in specialty formulation and Limited quantities are used in shampoos and medicated liquid soaps

Alkaline

Water soluble alkalis having detergent properties, but containing no soap Usually range in pH 9 – 12.5 Applications where a strong detergent is required such as removing heavy accumulation of dirt, scuff marks Generally used for hard surface cleaning High alkalinity is important in saponifying (converting to soap) fats and neutralising acids found in many types of dirt

Are greatly affected by changes in pH:  Acts like an anionic detergents at pH values greater or equal to 8  Acts like an non-ionic detergents at pH values between 8 and 6  Acts like a cationic detergent at pH below 4 Non-toxic Non-irritating Germicidal Compatible with anionic, non-ionic and cationic detergents Remove a wide range of dirt and soil Low foam properties

EX A

Amphoteric

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detergents for effective cleaning -Cannot be used in conjunction with anionic detergent – each will cancel the other out rendering the detergent completely ineffective Expensive

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Manufactured from weak alkalis and strong acids

-Take precautions when using on linoleum – can remove the linseed oil component in linoleum and adversely affect the wood flour component -Can affect pigment, causing it to fade or yellow -May remove water emulsion floor waxes -Some may form soluble salts which crystallise as efflorescence on the surface i.e. those containing sodium hydroxide -Requires to be rinsed thoroughly in order to prevent a white powdery residue from remaining on the surface -Multiple applications may cause damage to the surface

Infection Control Cleaning Management

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-Contact with bronze or copper will cause the metal to corrode Forms a scum, in hard water areas (calcium and magnesium salts present in hard water reacts with the soap) May cause a greasy build up on the surface which can be slippery

Soap

A surfactant Produced from naturally occurring fats and oils

-Very effective as a bactericide -Will form gels, emulsify oil and lower the surface tension of water -This allows the soap to come into contact with a greater surface area than water alone

Caustic materials

Based on caustic soda, sodium hydroxide, caustic potash or potassium hydroxide High pH value

Use when very strong alkaline solutions are required such as in clearing blocked drains, oven cleaners

-Safety hazard to user as corrosive to flesh, flammable when in contact with organic solvents -Increases the temperature of water when dissolved at high levels -Corrosive to soft metals, ceramic or glazed surfaces -On floor covering, the strong alkalinity will produce irreversible damage

Advantages

Disadvantages

One stage process Frequently used for a short defined period i.e. outbreaks Frequent touched surfaces Frequent touched items High risk areas

-Use in a well-ventilated area -Is corrosive to metal -Will bleach fabric -Damage the skin and mucous membranes -Unstable once in solution form -Do not use for large spillages â&#x20AC;&#x201C; large quantities of chlorine gas may be generated, necessitate evacuation of the area -Must not be applied directly to acidic body fluids i.e. urine or vomit as chlorine vapour will be released

Type of combined products

Designed to eliminate the need for separate cleaning disinfection processes

EX A

Chlorine releasing and detergent combined

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Type of disinfectant Alcohol

Wipes impregnated with 70-90% alcohol (ethyl alcohol or isopropyl alcohol (watersoluble chemicals)). The antimicrobial activity can be attributed to their ability to denature proteins. They are used to disinfect small surfaces.

Sodium hypochorites have a broad spectrum of antimicrobial activity, are unaffected by water hardness and are fast acting

Advantages

Disadvantages

Rapidly bactericidal rather than bacteriostatic against vegetative forms of bacteria, Gram positive and negative, they are also tuberculocidal, fungicidal and virucidal against enveloped viruses

-Lead to deterioration of some materials -Evaporates quickly, Is flammable -Not effective against bacterial spores -Have limited effect against nonenveloped viruses -Need time to work and May not penetrate organic material -Not effective against spores -Use in a well-ventilated area -Hypochlorite should not be used on its own for combined cleaning and disinfection -Sensitive to present of organic matter -Corrosive especially on metals when solutions are >500ppm -Bleach fabrics -Damage the skin and mucous membranes -Must not be applied directly to acidic body fluids i.e. urine or vomit as chlorine vapour will be released -Must not be mixed with hot water or any other cleaning agent as chlorine vapour will be released -Release of toxic chlorine gas when mixed with ammonia or acid

-Eliminate both enveloped and nonenveloped viruses if used in correct dilution and contact time -Effective against fungi, bacteria and algae Hypochlorite is widely used in healthcare facilities, including spot disinfection of floors and work surfaces, disinfection of areas and rooms following infection

EX A

Chlorine and chlorine compounds

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-Must not be mixed with hot water or any other cleaning agent as chlorine vapour will be released

Chlorine releasing agents

-Chemical disinfectants which are effective

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-Use in a well-ventilated area

Infection Control Cleaning Management

Is corrosive to metal when solution are > 500ppm -Will bleach fabric -Damage the skin and mucous membranes -Unstable once in solution -Do not use for large spillages â&#x20AC;&#x201C; large quantities of chlorine gas may be generated, necessitate evacuation of the area -Must not be applied directly to acidic body fluids i.e. urine or vomit as chlorine vapour will be released -Must not be mixed with hot water or any other cleaning agent as chlorine vapour will be released

Stable and effective disinfectant on inanimate surfaces, and is also effective in spot disinfection of fabrics

3% concentration is the minimum requirement to be effective against microorganisms such as Clostridium difficile

Should not be used on its own for combined cleaning and disinfection

-Effective surface disinfectants for gram negative rods, mycobacteria species and enveloped viruses -Effective at cell lysis -Persist for long periods after application Stable -Active in presence of organic matter -Active against a wide range of microorganisms

-Lack of validated efficacy date -Residual disinfectant on porous materials -Tissue irritation, even when rinsed thoroughly

-Good agents, but high water hardness and materials such as cotton may make them less microbiocidal because these material absorb the active ingredients -Carry a very strong positive charge that makes

-Gram negative bacteria have been found to survive or grow in these preparations -Not effective against non-enveloped viruses, fungi and bacterial spores -Prolonged contact can be irritating

Can be vaporised by a special generator in a concentration that destroys microorganisms. Damage lipid membranes, are highly effective against vegetative organisms and many viruses

EX A

Phenols and Phenolic disinfectants

against blood-borne viruses -Rapid in action -Disinfectant of choice in the event of a spillage of blood or body fluids, -Less resistant than hypochlorites to organic matter -Less corrosive than hypochlorites -Available as granules or tablets, which are stable when sored dry -Long shelf â&#x20AC;&#x201C; life

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Hydrogen peroxide

Sodium dichoroisocyanurate (NaDCC) have a broad spectrum of antimicrobial activity, are unaffected by water hardness and are fast acting

Quarternary ammonium compounds

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Widely used for general environmental cleaning, and decontamination of noncritical surfaces such as floors, walls and furniture

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Appendix 2 Sample Risk Assessment

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good contact with negatively charged surfaces -Generally low in toxicity -Used for sanitation of non-critical surfaces such as floors, walls and furniture

What is the Hazard

Who might be harmed and how

What controls have you already got in place

What further Actions do you need to take

Contact with cleaning fluids

Cleaning staff risk getting skin problems such as dermatitis and eye damage if direct contact to eye or skin with bleach or other cleaning fluids e.g. detergents.

Staff asked when appointed if they suffer ill health, eg skin problems, when using chemicals

Investigate replacing any chemical marked “irritant” with a milder product if appropriate

EX A

Chemicals vapours may cause breathing problems

Staff reminded to report any health problems thought to be caused from cleaning activity.

Long handled mops. PPE such as gloves and goggles provided

COSHH Data sheets available All staff trained in the risks, use and storage of chemicals

Staff reminded to wear PPE and wash hands after handling chemicals and on removing gloves.

Chemicals are not decanted and all containers are labelled

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Who needs to carry out the actions Manager

All Staff

Manager & staff

Date action to be competed