Healthcare Hygiene magazine November 2019 | Seite 32

Continued from page 31
Let’s examine each of the four steps:
The process begins with a
visual assessment. As Dancer
and Kramer (2018) advise,
“Every cleaner should inspect
the area to be cleaned and consider overall con-
ditions and degree of visual contamination before
beginning a cleaning task.”
STEP 1
LOOK
This step explains why and how the
area to be cleaned needs to be prepared
for cleaning. Healthcare environmental
services staff should survey the area
to be cleaned, ascertaining the most appropriate level of
cleaning, what should be cleaned and how, and being sure
to use the proper tools and cleaning/disinfection chemistries.
STEP 2
PLAN
As Dancer and Kramer (2018) explain, “Cleaning refers to the removal of soil from surfaces by use
of physical wiping or scrubbing; the chemical action of a surfactant or detergent; and water to wet,
emulsify or reduce surface tension. The process removes both dirt and microorganisms from surfaces,
thereby reducing the amount of organic bioburden. Cleaning should always precede disinfection because
the presence of soil will impede disinfectant activity. Some hospitals use detergents for routine cleaning, while others
choose products that either inactivate or kill living microorganisms. This is termed ‘disinfection’ or ‘hygienic’ cleaning …
Cleaning and disinfection become inextricably intertwined when wipes are impregnated with disinfectant as the overall
effect is a combination of disinfectant activity and physical removal of soil.”
STEP 3
CLEAN
They emphasize some of the best practices relating to cleaning and disinfection:
 Clean from high to low, then clean sites nearest to the patient first, then sites furthest from the patient (e.g. door
handle, sink, bathroom.
 Make high-touch/ hand-touch sites a priority.
 Clean a site from least visually dirty to obviously dirty.
 Wipes should be used according to manufacturers’ instructions. Use one wipe for each site; some sites may require
several wipes (e.g. bed frame). Unfolding the wipe and using it flat on the surface maximizes the area cleaned and
minimizes the amount of hand contact. Wipe in one direction without retracing the area already cleaned; apply the ‘one
wipe; one site; one direction’ principle.
 Be aware that microbes may be transferred between surfaces (via gloved hands, cloths, etc.)
 Always remove visible soil with detergent and water before the use of disinfectant.
 The physical removal of soil and microbiocidal activity from disinfectant may be achieved by use of a disinfec-
tant-containing wipe.
 The researchers emphasize, “Sites such as bed rails, bed control (if electric-bed), nurse call bell, bedside locker and
bed table constitute the highest priority for cleaning because they are frequently touched and readily provide a reservoir
for hospital pathogens. There is a two-way direction of transmission between these surfaces and hands, which can only be
disrupted by targeted cleaning and hand hygiene. Given that cleaning usually occurs just once per day, and hand hygiene
depends on a multitude of factors, it comes as no surprise that infections are readily acquired from bed-space sites.”
The final stage encompasses physical drying of surfaces. As Dancer and Kramer (2018) note, “The
cleaning process is not complete until all surfaces are completely dry. Contact time is usually considered
critical to disinfection, but it can be difficult to fulfil in a time-pressured healthcare environment.” They
add, “This fourth stage should also include the cleaner’s own assessment as to overall cleanliness of
the bed space or room. If they are satisfied that the process is complete, the area can be signed off verbally or by written
notification, labelling or use of a checklist. Further monitoring helps to maintain, and improve, the quality of cleaning
but it is not necessarily mandatory and will depend upon available resources …When leaving the patient area, the gloved
hand should be subjected to hand disinfection if the cleaner has to fulfil further duties before the next cleaning objective.
Otherwise, gloves and any other protective apparel may be removed, and hands washed and dried before further duties.”
STEP 4
DRY
Reference:
Dancer SJ and Kramer A. Four steps to clean hospitals: LOOK, PLAN, CLEAN and DRY. J Hosp Infect. December 2018.
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november 2019 • www.healthcarehygienemagazine.com