Visually clean, or hygienically clean?

16th of September 2011
Visually clean, or hygienically clean?
Visually clean, or hygienically clean?

Often, consciously or unconsciously, the assessment of cleaning is based only on the visual result. Surfaces and floors are considered clean when no dirt or smears are evident. But mopping systems specialist Vermop asks, is this always enough? Is a more differentiated approach needed in individual areas? Is 'apparently pristine' the same as hygienically clean?

Appearance is an important aspect in assessing whether cleaning has been carried out correctly. When there is no evidence of dirt or smears, the area is considered clean. This often applies even in hygienically-sensitive areas such as hospitals, residential facilities for the elderly and nursing homes.

But the number of hospital-acquired infections is rising steadily from year to year and altered microorganism habits are reported on a regular basis. For this reason, it is important in assessing hygienic cleaning to include criteria other than, and more detailed than, a clean appearance alone.

These are, for example, the cleaning processes and methods used, the organisation of the cleaning procedure in the individual areas, the frequency of cleaning, the organisation of the cleaning trolley and the level of knowledge of the cleaning staff regarding cleaning and hygiene.

All these points should be subjected to a risk assessment. This ensures that bacterial contamination in cleaning is reduced or even made impossible.

Many hospitals are faced with the problem of rising infection rates so they assess individual areas intensively and critically in order to get the resulting problems of resistant and altered microorganisms under control. This is where cleaning has a significant influence.

When patients are admitted, it is not usually clear whether or not they are the carriers of infectious diseases. This can only be determined through time-consuming tests. While they are waiting for results, regular general cleaning is carried out without special standards or safety measures.

Habits of microorganisms

The spread of microorganisms can only be understood when their fundamental habits are familiar. The most significant feature of microorganisms and bacteria is their tiny dimensions. They are only a few thousandths of a millimetre in size. The bacterial cell contains very little space for the storage of different enzymes or proteins. However, the high adaptability of the microbial metabolism means that it is always able to produce the enzyme required to process a nutrient.
There are many nutrients for bacteria, eg, dirt, the dregs of beverages and body fluids. At the same time, their requirements in terms of variety are low.

Humans as carriers

In the transmission of infectious diseases, humans play a major and very significant role as the natural reservoir for microorganisms. These can be passed on by sneezing or coughing, for example, through hand and skin contact or through the excretion of urine, blood and faeces. The germs which cause influenza are transmitted via the air we breathe. E.Coli, for example, is passed on through the gastrointestinal tract and Staph. Aureus via the skin. These are just a few examples from the huge range of microorganisms.

The danger of microorganisms being spread through cleaning staff is particularly high. They come into contact with many patients, medical staff and visitors as well as passing through numerous rooms, areas and wards. And they do so with above-average frequency. Therefore a high level of personal hygiene is particularly important for cleaning staff.

Cleaning material as a carrier

A cleaning sponge which is used in a number of areas offers bacteria a huge reservoir in which microorganisms can multiply particularly freely. In order to curb reproduction, these points have to be observed in the selection of cleaning utensils:

•Cleaning utensils may offer no breeding grounds for microorganisms

•Cleaning utensils should permit disinfection or be washable at 95°C. Critical items are, for example, wooden handles

•It should be possible to remove dirt and microorganisms easily and thoroughly from the surface.

Hygiene fundamentals

It is particularly important to minimise the further spread of germs through cleaning. With regard to cross-contamination and the spread of germs, special consideration should be given to the organisation of cleaning processes.

Important points for hygienic cleaning:

•Cleaning should ensue from the top down and from the back to the front, ie, to the exit door.

•Surfaces are only considered hygienically clean when they have been wiped with a cloth. Microorganisms can only be removed by being wiped away. This principle also applies for the cleaning of floor coverings. Through correct cleaning alone, germs can be reduced by up to 80 per cent .

•Fresh cleaning covers and cleaning cloths should be used for each patient room.

•Patient rooms which may be the source of infection should always be cleaned and disinfected at the end of a cleaning day.

Course of action for hygienic cleaning in a hospital room:

Cleaning the sanitation area:

•Pour sanitary cleaner into the WC bowl and allow it to work

•Remove refuse

•Clean the WC bowl and the direct vicinity with a clean cloth in the predetermined colour (eg, red)

•Clean other surfaces with a clean cloth in the predetermined colour (eg. yellow)

•Clean the floor with a clean sanitary cover.

Cleaning a patient room:

•Remove refuse

•Clean the areas furthest from the patient first, then those close to the patient. Clean the floor with a fresh cleaning cover which moistens the floor area and then lifts the loosened dirt.

Cleaning surfaces

The surfaces in the patient room of a hospital are divided into near-patient areas and those further removed from the patient. The deciding factor is how frequently skin and hand contact occurs (eg, door handles, light switches, bed frame, bell, bedside locker, table, chairs).

Such surfaces as door handles and light switches, with which people frequently come into contact are always to be regarded as critical and must therefore be given particular consideration.

An important aspect when cleaning surfaces is the transmission of microorganisms through cleaning equipment or textiles. A chain of infection from the human to the object and then back to the human is a very real possibility. This route of transmission is interrupted only though hygienic cleaning and disinfection. In order to prevent microorganisms spreading, special emphasis must be placed on this interruption.

Cleaning textiles made of microfibre have a better mechanical effect on the surface than other materials. As a result, a larger number of microorganisms and dirt particles can be removed than with other textiles.

Therefore cleaning cloths and covers with a microfibre content should be chosen in preference to other materials.

Cleaning and disinfection plans

For all cleaning in hygienically-sensitive areas, cleaning and disinfection plans are absolutely necessary, and are actually mandatory in some countries. These plans should be displayed directly on the cleaning trolley. Furthermore, the cleaning staff must be trained in the use of this plan at least once a year.

The plan should be structured into the following areas:

•What has to be cleaned?

•What is used for cleaning?

•How is cleaning carried out?

•How frequently is cleaning carried out?

Pictures and pictograms make the plans easy to read and understand.

Cleaning method

A further step toward reducing the spread of germs is the selection of the cleaning method.
From a hygiene and ergonomic perspective, it makes sense to use pre-wash process with pre-soaked cloths. The cloths should be stored in a closed box or bucket with a lid in order to avoid cross-contamination. When cleaning cloths are repeatedly dipped into the same cleaning or disinfection solution, microorganisms detach themselves from the cloth and remain in the solution. They can then contaminate the next cloth dipped in and be transferred to other areas - where they can lead to infection.

When surface cleaning is completed in a patient room, the cleaning cloths must be hygienically collected in a laundry net. Under no circumstances may they be left lying around on the cleaning trolley. This is the only way of avoiding the spread of germs and contamination.

When choosing the cleaning method for the floor, the following points are decisive:

•The method must be simple and easily learned

•The spread of germs should practically be ruled out by the use of this cleaning method.

Over the years, cleaning methods in which the cleaning covers are pre-soaked in the cleaning liquid or disinfectant solution have proved their worth, particularly in hospitals. For this pre-wash process, the covers are placed in a box and a defined quantity of the cleaning or disinfection solution poured over them. The cleaning operative then attaches the covers directly from the box to the holder, ergonomically and without touching them.

The choice of method should be based on hygiene considerations. Sources of error should be ruled out to the greatest possible extent. The use of cleaning systems which allow two-stage wiping with a double-sided mop are to be recommended.

This means that dirt particles and microorganisms can be loosened with one side of the cleaning cover and then removed from the floor with the other side. After cleaning, the covers are discarded without direct contact. The mop should be discarded into a sack with a lid, so that here too the spreading of germs is reduced.

Hygiene benefits of this cleaning method:

•Cover change is carried out without direct contact with the cover

•The removal of microorganisms and dirt is more effective than in the one-stage wiping process

•The spread of germs is reduced.

A further interesting cleaning process is that involving a disinfectant tub and a two-sided cover. Cleaning solution or disinfectant solution is added to a disinfection tub with dosing unit. By operating a pedal with the attached mop, the lower side of the mop is saturated with moisture.

The second mop side, which is on the top, remains dry. The floor area is cleaned with the moistened side and then the mop is turned so that the dry side can lift the loosened dirt. After the floor has been cleaned, the mop is discarded into the laundry sack.

Hygiene benefits of working with the disinfection trolley:

•Cover change is carried out without direct contact with the cover

•The removal of microorganisms and dirt is more effective than in the one-stage wiping process

•The moisture in the cover can be flexibly regulated

•The spread of germs is reduced.

The colour system

One fundamental principle of hygienic surface cleaning is the use of a consistent colour system. The cloths in different colours are assigned to the individual cleaning areas (WC, area around washbasins, surfaces). In this way, faecal germs which are normally found around the WC cannot be transferred to the patient’s bedside locker.

Hygiene benefits of the colour system:

•The danger of the cloths being mixed up is reduced

•The instruction of cleaning staff who speak different native languages is simplified as the method is so easy to understand

•The spread of germs is reduced

•The trolley is clean and hygienic

•Ergonomics are improved as staff do not have to wring out the cloths

•Exact dosing cuts down on the consumption of water and cleaning chemicals

It makes good sense to always park the cleaning trolley directly in front of the door of the room to be cleaned. This makes it a signal for staff in the building, patients and visitors. Caution – cleaning in progress in this room. The floor covering could be wet and slippery. The cleaning trolley does not get in the way in the room to be cleaned. Fewer germs are spread from room to room.

The cleaning trolley

The calling card in hygienic cleaning is the cleaning trolley which should also be set up in accordance with hygiene considerations:

•Easy to clean and, where necessary, to disinfect

•No hard-to-reach corners and niches

•Use of a chemical centre to store chemicals so they are not freely accessible

•Covered disposal sacks.

•Clean and tidy cleaning trolley. It should only be stocked with items which are really needed for general cleaning.

Regular hygienic cleaning lowers infection rates, cuts costs and reduces human suffering. Only responsible, well-trained staff guarantee appropriate hygiene. This is the principle which should apply for all staff training. Only in this way can be spread of germs be minimised and contained.


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