Training on Disinfecting and Cleaning

Environmental Services Department (EVS) Mission Statement

It is the mission of the Environmental Services Department to function as an integral part of Children's Hospital & Research Center at Oakland and provide quality patient care by maintaining a high standard of aseptic and physical cleanliness as well as a cheerful environment, consistent with Children's Hospital & Research Center at Oakland mission, goals, and values.

 These services are vital to patient care providers in their mission of

“providing comprehensive pediatric inpatient and outpatient services within the hospital’s total resources.”

New RegulationsDuring the past two decades, health-care-associated

infections (HAI), especially those that are resistant to commonly used antibiotics, have increased dramatically in California. MRSA is one example of an HAI. In response to this growing issue, CA Senate Bill 1058 and Senate Bill 158 were passed; which are known as the Medical Facility Infection Control and Prevention Act or Nile’s Law. This law was passed to manage and minimize health-care-associated infections.

This new law requires more thorough cleaning and sanitation to help control the transmission of infectious diseases such as MRSA, VRE.

Regulatory Impact on EVS

Regular disinfection of all restrooms, countertops, furniture, televisions, telephones, bedding, door knobs office equipment, and surfaces in patient rooms, nursing stations, and storage units. SB1058 (e)(2)

Cleaning and disinfection of all movable medical equipment and transportable medical devices within EVS responsibility. SB1058 (e)(3)

Regular cleaning and disinfection of all surfaces in common areas in the facility such as elevators, meeting rooms, and lounges. SB1058 (e)(4)

Environmental services staff shall be trained by the hospital and shall be observed for compliance with hospital sanitation measures. The training shall be given at the start of employment, when new prevention measures have been adopted, and annually thereafter. Cultures of the environment may be randomly obtained by the hospital to determine compliance with hospital sanitation procedures. SB158 (d)

Hand Hygiene Compliance Knowledge of Universal Precautions

Center For Disease ControlThe Center for Disease Control (CDC) report that studies show there is a decrease in disease transmission when housekeeping personnel persistently follow cleaning procedures, which includes increased cleaning and disinfection of frequently-touched surfaces (e.g., bedrails, bedside commodes, doorknobs).

Training ContentHand Hygiene Compliance Universal PrecautionsBlood and Body Fluid SpillsReview of equipment,

furniture, and other areas that Environmental Services (EVS) is responsible for cleaning and disinfecting

Cleaning procedures

Hand HygieneWhen do you need to wash your hands with soap and water?Hands are visibly soiledBefore eatingAfter using the restroomAfter cleaning every third patient roomEach time entering and exiting isolation rooms

When do you use an alcohol-based hand rub or hand washing with water and soap? Before and after direct patient contactBefore donning sterile glovesAfter removing glovesAfter contact with objects and equipment in the patient’s immediate vicinityBetween patient rooms

Hand Hygiene Policy Wash hands often and well, paying particular

attention to around and under fingernails and between fingers. Sing “Row Row Row Your Boat” (for 15 seconds) while washing your hands.

All healthcare workers entering or working in the patient care areas are not permitted to have jewelry on fingers, artificial/acrylic nails, overlays, tips, nail wraps, and/or any type of accessory. This includes but is not limited to applications of glue, and or any other substances that may infringe upon the nails natural integrity. Natural nails must not be longer than 3 millimeters above the base, however 1 millimeter is preferred.

Universal PrecautionsStandard Universal Precautions Are used for all blood, body fluids, secretions, and excretions of all patients. Include wearing Personal Protective Equipment (PPEs) whenever it is anticipated that you will come in contact with the blood, body fluids, secretions, or excretions of any patient.

Personal Protective Equipment (PPE) Gloves should be used when performing a task where your hands may come in

contact with blood, body fluids, sections, or excretions of any patient. Gown should be worn when performing a task where it is anticipated that your clothing

will become contaminated with blood, body fluids, sections, or excretions of any patient or when entering an Isolation Room and the OR.

Mask/Eye Protection should be worn when performing a task where it is anticipated that your eyes, nose and/or mouth will be contaminated by the splashing of blood, body fluids, secretions or excretions of any patient or when entering an Isolation Room (N95 for TB, surgical mask for Chicken Pox). Must be fit-tested for N95 respirator.

Handling Blood and Body Fluid Spills

Wipe up all visible blood and body fluid spills immediately using a mop or rag. Gloves must be worn. 

Disinfect the area with a hospital approved germicide. Floors which are wet should contain a safety sign to

prevent slips and/or falls.

Needles, Syringes & Other SharpsEnvironmental Services ResponsibilityUse extreme caution when handling sharps.Clean sharps container holder or bracket daily using damp cloth with

disinfectant.Remove full sharps container from the Soiled Utility Room daily. Wear

gloves and ensure that the sharps container lid is securely closed.All full disposal units are placed on an infectious waste cart and taken

to the outside medical waste storage area. Ensure the medical waste storage area is locked.

Non-Sharps Biohazardous Waste

All bio-hazardous waste shall be segregated from other waste and will be placed in single red plastic bags labeled “DANGER” - BIOHAZARDOUS WASTE”.

Bio-hazardous waste bags shall be placed in bio-hazardous waste receptacles located in the soiled utility room.

Biohazardous waste receptacles shall have tight-fitting lids and be labeled “BIOHAZARDOUS WASTE”.

Daily: Reusable containers will be cleaned using one of the following two methods: Thoroughly wash the container for 15 seconds using a hot water supply

of at least 180 degrees Fahrenheit, OR Clean with an approved germicide.

Non-Sharps Biohazardous Waste ContinuedStandard biohazardous waste containers

are used to hold and transport single-bagged bio-hazardous waste separate from regular trash and soiled linen.

Remove the biohazardous waste from the unit at regular intervals, tie a double knot at the top of the bag and transport it to the secured holding area wearing personal protective equipment during transport.

The floor and general area will be cleaned daily using an approved germicidal detergent.

Ensure biohazardous waste storage areas are locked.

What is EVS responsible for cleaning?COMMON AREAS AND SHARED EQUIPMENT

Frequency: Cleaned upon discharge or transfer of patient and daily as per Environmental Services (EVS) policy.

Cleaning Method: Quaternary Ammonium & upholstery cleaner.

Furniture Responsible Department

Toys – Only wall mounted units, play tables

EVS

Elevators EVSLobby Furniture EVSOffice Equipment EVSNursing Stations EVSStorage Units EVSStaff Lounge EVSPublic Restrooms EVSDoorknobs EVS

What is EVS responsible for cleaning? (continued)

PATIENT FURNITUREFrequency: Cleaned upon discharge or transfer of patient and daily as per

Environmental Services (EVS) policy.Cleaning Method: Quaternary Ammonium and upholstery cleaner.

Furniture Responsible DepartmentCrib EVSBassinet EVSBed EVSBedside Cabinet EVSBedside Table EVSCloset doors EVSChair(s) EVSNightstand EVSOverbed Table EVSTelevision EVSTelephone EVSCounter tops EVS

What is EVS responsible for cleaning? (continued)

REFRIGERATORS, ICE MACHINES, AND PIXISFrequency: Cleaned as needed and per department policy.Cleaning Method: Use disinfectant.

Equipment Responsible Department

Comments

Ice Machine EVS, Engineering

EVS daily; Engineering for PM

Pyxis EVS EVS surface onlyRefrigerator, Staff Food EVS Cleaned once monthly,

defrost as needed

What is EVS responsible for cleaning? (continued)PATIENT ROOMS AND EQUIPMENT

Frequency: Cleaning between each patient and as needed.Cleaning Method: Quaternary Ammonium, unless otherwise noted.

Equipment Responsible Department

Comments

All Surfaces in Patient Rooms EVS Including bathrooms and floorsBed Overlay EVSCommode EVS, Nursing Emptied by Nursing, disinfected by EVS. Hardwired BP Monitor – ICU EVS Upon dischargeHighchair EVS, Nursing Upon dischargeIsolation cart EVSIV Pole Nursing, EVS Nursing cleans as needed; EVS wipe down upon

dischargeMonitors/Lead Wires Monitor Tech,

Nursing, EVSDischarge Clean: EVSBetween Patients: Nursing, Monitor Tech

Scale - bed EVS, Nursing EVS upon dischargeScale - standup EVSSleep Chair EVSSliding Board EVS OR OnlyWarming Table EVS

General Cleaning Instructions VIREX is the approved disinfectant used at Children’s Hospital

Oakland. Use the automatic mixer for proper dilution of cleaning chemicals. When dispensing chemicals, use the following personal protective

equipment: chemical splash goggles, chemical resistant gloves of natural rubber latex, protective clothing and footwear.

Use proper and approved supplies and equipment – being sure NOT TO USE spray bottles.

Establish a safe, clean environment within the seven steps and scope of cleaning.

Utilize cleaning and disinfectant methods prescribed in policies and procedures.

ChemicalsWear PPEKnow where MSDS (Material Safety Data Sheet) is located.You should review the MSDS before using the product for the

first time.Never store chemical near heat or electrical equipment.Never mix chemicals. Never mix Ammonia and Bleach. Fumes

from this combination are deadly.All bottles must be labeled. Never try to guess what is not

labeled.

Cleaning Occupied Patient Room Daily Follow seven step process Empty wastebasket, wipe, and

replace liner. Damp wipe furniture, fixtures, &

telephone. Damp wipe doorknobs. Damp wipe the door and door frame. Spot clean walls, windows, and

baseboards, as needed. Inspect cubicle curtains for stains

damage and notify the supervisor/manager if they need to be replaced.

Clean sink and wipe sink top

  

Wipe bathroom light fixture; sink pipes, mirror, towel box, and grab bars.

Wipe down shower walls and door, and mop the shower floor.

Wipe outside of toilet bowl and all seat surfaces with disinfectant.

Scrub toilet bowl with approved toilet bowl cleaner.

Replenish paper towels, toilet tissue and seat covers, and soap.

Cleaning Occupied Patient Room ContinuedDaily Clean the top and sides of the television Dust the walls, clock, and picture. Clean ceiling lights (surface). Dust vents (outside only). Damp mop carpet, if any, along the baseboards. Scrub body oil, soap scum and rust from shower walls, door, and fixtures. Scrub vinyl furniture and/or vacuum fabric. Spot clean the windows and sills. Vacuum or damp wipe drapery valence/blinds. Wet mop floor with disinfectant. Report cracks, chipped paint, broken floor tiles, water-stained ceiling tiles

and other repair needs to supervisor/manager. Wipe sharps container holder/bracket. (For OPC, replace sharps container

when full)

Follow seven step process.Notify nursing of patient items left behind.Put patient assistance tent card on bedside stand. (if

applicable)Re-arrange all furniture and do a visual check of the

room.Notify nursing that the room is ready for occupancy.

Cleaning Patient Room After Discharge Continued

Cleaning Isolation/Airborne Disease Patient Room - Daily Wash hands. Put on mask and gloves, as required, immediately

before entering the room (and no sooner). Clean room using seven step process (same as

other patient rooms). Use three black bags for trash, two red bags for

medical waste, and two blue bags for linen. Double bag trash, medical waste, and linen. Use black trash bag for rags.

Remove personal protective equipment and properly dispose.

Wash hands. Exit the room.

Cleaning Isolettes, Incubators, Cribs, and Ohio TablesThoroughly clean the equipment using an

approved disinfectant.After cleaning, use the Cleaning Log to verify

cleaning of equipment by lacing ID of bed, date cleaned, attach a “clean YELLOW sticker”, and initial the equipment.

EVS management will inspect the equipment to make sure that it has been properly cleaned and then date and initial the YELLOW sticker, noting their approval of the equipment for use.

No equipment will be taken to the patient floor area unless both the EVS Aide and Management approval has been clearly noted on the bed, with date included.

Equipment will be covered with plastic for storage and during delivery to Nursery.

Main Hospital Bed StorageNursing will call Children’s EVS department stating a need for bed(s) to be removed from a floor. EVS will take the following action:All beds removed from any patient care area must be sanitized with a hospital approved germicidal solution before removal and placed in bed storage. This sanitation is the responsibility of the area cleaner assigned to the room from which the bed is removed. No linen, toys, charts, etc. will remain on any bed going to storage.Nursing personnel will be responsible for assuring the beds are sanitized and the removal of the aforementioned items has occurred.

Between Case/Terminal Cleaning Of Surgical SuiteEnvironmental Services Aide

will change into scrubs before entering the surgical suite.

Proper hand-washing technique must be followed before entering the surgical suite.

Housekeeping equipment used in the surgical suite is not to be shared by any other area.

Cleaning Of Surgical Suite ContinuedPost Case Cleaning Prepare equipment, clean, and check. Prepare germicidal solution in the mopping bucket and small plastic

pail. Proceed to the surgical suite, remove trash and soiled linen. Reline

trash receptacles and soiled linen hampers. Clean and disinfect the table bed, covering every surface. Disinfect all furniture (ring stands, kick buckets, tables, etc.), rinsing

cloth after each item in the same room. Disinfect (spot clean) walls and lights over the table bed. Damp mop floor with germicidal-detergent solution (move table bed for

mopping). Replace furniture and table bed in their proper place.

Between Case/Terminal Cleaning Of Surgical Suite (Continued)

Post Schedule Cleaning Disinfect ceiling, walls, and fixtures on the walls, being careful not to get solution in or

behind hemostats, thermostats, X-ray screens, sterile cabinet doors, electrical outlets, etc.

Using double buckets lay germicidal-detergent solution on the floor, scrub and vacuum up solution, leave a 12-inch wet strip close to and around the furniture that is still in middle of the room.

Replace the furniture, being sure to roll its wheels through the wet strip to disinfect them. Then roll the table bed through the solution to one side of the room.

Disinfect the light fixtures. Lay solution on the floor in the middle of the room, scrub and vacuum up the solution. Replace the table/bed to its proper place. Clean all equipment used with germicidal solution thoroughly and store properly. Corridor ceilings and walls will be disinfected monthly, spot wash as needed.

Micro Mop SystemMicro Mop is used in all patient

rooms.One or more micro mops must be

used (according to the condition of the room) for each patient room.

Used micro mop must not be reused in another room.

Dirty micro mops must be deposited in the area located on the 1st Floor EVS Supply Room.

 

Micro Mop System ContinuedGet the amount of mops for the number of

rooms, plus two (2) extra.Use germicidal solution only.Attach the micro mop to the base of the handle.Place the wet sign outside the door before

starting to mop following the Seven (7) Steps standard cleaning procedure.

To use the bottle chemical solution, pour the chemical directly to the micro mop until you get the right consistency to wet the mop. Mop the floor following the Seven (7) Steps standard procedure.

Cleaning Procedure (Linen Carts/storage)Exchange CartsCarts shall be wiped down weekly with a germicidal solution. Exchange Cart CoverCover shall be wiped down weekly using a germicidal solution. Linen RoomDusting shall take place once a week with a germicidal

solution (including fans, vents, shelves, desk, tables, chairs, etc.). The floor shall be swept and mopped daily. The floor shall be buffed every other week and waxed as needed. Empty trash daily.

 Clean Linen ClosetsOnce a week shelves shall be dusted with a germicidal

solution.

Soiled Linen  All soiled linen must be disposed of in the proper plastic liner

(blue), which is designated by color to identify it as soiled linen. The bags must be tied at the top to prevent spills.

EVS is responsible for the removal of soiled linen and will transport the individual bag(s) to a designated holding area.

EVS personnel disposing of the soiled linen will unlock the door to the interim holding area and place the bag(s) in the transport carts. The door will be locked after each use.

Soiled Linen Collection Room:o Carts will be located in the collection room to receive

the bagged linen. These carts will be transported on a specified schedule.

o The cart used for transporting soiled linen will be loaded onto the trailer provided by the linen supply vendor and picked up by the linen vendor per the agreed upon schedule.

Cleaning Public RestroomsDaily: Using the Seven (7) Step Process  Replenish soap and paper supplies as needed. Remove trash, clean container and replace liner. Empty sanitary napkin receptacle. Replace liner. Clean sinks. Damp wipe light fixtures and mirrors. Damp wipe walls and partitions (including top of partitions). Report any graffiti,

which cannot be removed. Clean toilets and urinals. Wipe outside of toilets and urinals and all seat

surfaces of toilets with germicidal detergent. Scrub inside of toilet bowls and urinals with approved toilet bowl cleaner.

Damp mop floor. Clean vent.

Public Restrooms (Continued)

Per Periodic Cleaning ScheduleMachine scrub the floors.

Cleaning Elevators DailyLock off elevator; place caution signs at doorway.Pick up large pieces of debris.Clean surface with germicidal solution.Clean elevator tracks. Vacuum using a crevice tool and damp wipe to remove spots and dried on soil.Dust mop or vacuum floor, as appropriate. Remove gum and other sticky substances with putty knife.Wet mop floor.Polish all stainless steel, particularly door edges.Remove caution signs and turn on elevators.  Weekly or Per Periodic Cleaning Schedule Machine scrub and buff floor. Re-apply floor finish.

Cleaning Lobbies And Waiting Rooms

Daily Straighten magazines, discard

unattended or day old newspapers.

Damp wipe all furniture and fixtures, including door knobs with germicidal detergent

Spot clean walls.Clean windows and glass.Spot clean and vacuum carpet.Empty trash receptacles, clean

and reline.

 

Cleaning Lobbies And Waiting Rooms ContinuedDaily Continued  Clean the baseboards. Scrub furniture as needed with cleaner and

scrub pad or spot clean fabric, as appropriate.  Clean windowsills and blinds.  Dust walls and wall fixtures.  Damp wipe furniture surfaces, door, door

frame and door knobs with germicidal solution.  Clean vents.  Clean carpets.  Clean ceiling light fixtures.  

Cleaning Conference RoomsDaily (And Between Conferences, As Needed)If food and beverage is still in the room, check to ensure conference is over. Empty trash, wash receptacles if necessary, replace liner.Damp dust all furniture, telephones, counters, doorknobs with germicidal solution.Spot clean walls.Vacuum and spot clean carpet.Clean baseboards.Remove fingerprints and spots from glass and windows.Clean chalkboards and/or greaseboards.Set up conference for next meeting as per schedule. 

Cleaning Conference Rooms ContinuedDaily (continued)Damp dust lights and walls.Clean wall hangings, pictures and clocks.Clean vents.  Per Periodic Cleaning ScheduleShampoo carpet.Clean windows.Damp dust ceilings.Vacuum chairs per schedule.

Monitoring Success EVS Manager and/or Supervisors will observe and document compliance with

sanitation measures daily Infection Control will ensure random cultures of the environment are obtained to

determine compliance with hospital sanitation procedures. Documentation tools include:

• Attendance Roster at Mandatory meetings held three times per year• New Employee Orientation records

EVS will work with Infection Control to ensure hand hygiene compliance. The EVS Manager and/or Supervisor will observe hand hygiene compliance and

document staff actions at least weekly and submit a monthly report. The Hand Hygiene Audit Compliance Tool will be used. The EVS Manager and/or Supervisor will audit and document (e.g. through

environmental tours) staff for knowledge and ability to describe Universal Precautions. EVS will be evaluated through an EVS focused objective survey on infection control

practices at least annually.