for transmission to a second patient or as an indirect source via contaminated hands of healthcare personnel . As we know , proper and robust cleaning and disinfection of environmental surfaces can reduce healthcare-associated infections .
As CDC ’ s Core Components guidance ( 2020 ) acknowledges , “ To keep patients safe , hospitals must maintain a clean environment and minimize the presence of pathogens . No single blueprint exists for the best cleaning and disinfection method , but there are several foundational elements , or core components , that help establish and sustain a clean , safe environment that supports the safety of patients , healthcare personnel ( HCP ), and visitors .”
According to the CDC , the core components of environmental cleaning and disinfection are :
• Integrate environmental services into the hospital ’ s safety culture
• Establish a hospital cleaning and disinfection program with a defined management structure and multidisciplinary participation and oversight
• Include , at a minimum , representation from hospital leadership , quality , nursing , purchasing , facility management , IPC , and EVS .
• Hold regular meetings to review practices and quality measures and establish / review facility goals .
• Define program responsibilities , including evaluating effectiveness of the program using data from clinical surveillance , the environmental monitoring program , and the environmental cleaning and disinfection monitoring strategy
• Establish and maintain a clear reporting and accountability structure for EVS personnel
• Develop a performance evaluation and career advancement structure for EVS personnel and management that encourages excellence , rewards expertise and skills and optimizes retention
• Incorporate considerations for effective cleaning and disinfection into the design , structure , and layout of patient-care areas
• Educate and train all HCP responsible for cleaning and disinfecting patient-care areas
• Focus education and training for HCP responsible for cleaning and disinfection on : learning hospital cleaning and disinfection policies and following them ( correct practices are observed by a trainer ); understanding the basic concepts of pathogen transmission ; recognizing the impact of their work on infection control and patient safety ; protecting themselves while working through the proper use of personal protective equipment ( PPE ) and the safe use of chemicals and cleaning technologies ; infection control risks , including sharps safety ; and other aspects of worker safety as appropriate to the setting or situation
• Train all EVS personnel upon hire and at least annually , and when introducing new equipment or protocols . Keep records of training completion . If contracted services provide the training , make sure that it meets facility requirements . Re-train to address weaknesses discovered during routine monitoring activities or audits . Hold competency-based trainings that account for staff turnover , education levels , language and cultural barriers and multiple learning styles . Keep a record of competency for all personnel responsible for disinfecting patient care areas and reusable equipment . Update EVS management and personnel on trends in facility infection rates and prevention priorities .
• Select appropriate cleaning and disinfection technologies and products
• Make sure that cleaning and disinfection technologies and products are tailored to the setting and standardized as much as possible .
• Use a systematic process to select technologies and products , including advanced technologies ( e . g ., no-touch disinfection devices ), for patient-care areas .
• Convene all stakeholders , including the facility cleaning and disinfection program , EVS management , IP & C , materials management , and other relevant HCP in the decision-making process for factors such as compatibility with device manufacturer ’ s instructions for use , contact time , possible health risks , acceptability to HCP and patients , effectiveness in decontaminating a surface , impact on overall cleaning efficiency , required expertise and training , and effect on surfaces or devices of repeated exposure to a product .
• Standardize setting-specific cleaning and disinfection protocols
• Identify standardized , setting-specific protocols for cleaning and disinfection , including use of technologies and products .
• Emphasize that surfaces , including high-touch surfaces , must be cleaned effectively , accounting for differences in room layout , equipment , and patient risk .
• Clearly define responsibilities for the cleaning and disinfection of noncritical equipment , shared medical equipment , and other electronics ( ICU monitors , ventilator surfaces , bar code scanners , point-of-care devices , mobile workstations , code carts , airway boxes ).
• Ensure that staff involved in cleaning and disinfection are aware of their responsibilities and are appropriately trained to fulfill them .
• Ensure that cleaning and disinfection supplies are easily accessible ( cleaning cart and patient-care areas are adequately stocked ).
• Develop standardized protocols for routine ( daily ) and discharge / transfer ( also known as terminal ) cleaning and disinfection for each major patient care room type ( intensive care unit or ward ) or area type ( operating room , emergency department , radiology suite ).
• Make sure that the protocols are readily available ( posted online or available in hard copy ) for review by staff . Include in the protocols : Appropriate PPE for EVS personnel ; processes for routine and discharge / transfer cleaning and disinfection for specific pathogens ( C . difficile , Candida auris , norovirus , MDROs ) and other patient-level factors ( wounds , diarrhea ); facility-specific cleaning and disinfection technologies , products , and methods ; processes for easy identification of equipment and rooms that have been properly cleaned and disinfected and are ready for patient use ( tagging system , placement in dedicated clean area ); and develop policies and procedures for storage of patient and visitor personal items , which can make it difficult to properly clean a room .
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