Appendix A – Risk-assessment for determining environmental cleaning method and frequency
Best Practices for Environmental Cleaning in Global Healthcare Facilities with Limited Resources
The materials on this page were created for use in global healthcare facilities with limited resources, particularly in low- and middle-income countries. Environmental cleaning resources designed for U.S. healthcare facilities can be found at Healthcare Environment Infection Prevention.
[Reproduced directly from PIDAC, 2018]
Probability of Contamination with Pathogens
Heavy Contamination (score = 3)
An area is designated as being heavily contaminated if surfaces and equipment are routinely exposed to copious amounts of fresh blood or other body fluids (e.g., birthing suite, autopsy suite, cardiac catheterization laboratory, hemodialysis station, emergency room, client/patient/resident bathroom if visibly soiled).
Moderate Contamination (score = 2)
An area is designated as being moderately contaminated if surfaces and equipment do not routinely (but may) become contaminated with blood or other body fluids and the contaminated substances are contained or removed (e.g., wet sheets). All client/patient/resident rooms and bathrooms should be considered to be, at a minimum, moderately contaminated.
Light Contamination (score = 1)
An area is designated as being lightly contaminated if surfaces are not exposed to blood, other body fluids or items that have come into contact with blood or body fluids (e.g., lounges, libraries, offices).
Vulnerability of Population to Infection
More Susceptible (score = 1)
Susceptible clients/patients/residents are most susceptible to infection because of their medical condition or lack of immunity. These include those who are immunocompromised (oncology, transplant and chemotherapy units), neonates (level 2 and 3 nurseries), and those who have severe burns (i.e., requiring care in a burn unit).
Less Susceptible (score = 0)
For the purpose of risk stratification for cleaning, all other individuals and areas are classified as less susceptible.
Potential for Exposure
High-touch surfaces (score = 3):
High-touch surfaces have frequent contact with hands. Examples include doorknobs, telephone, call bells, bedrails, light switches, wall areas around the toilet and edges of privacy curtains.
Low-touch surfaces (score = 1):
Low-touch surfaces have minimal contact with hands. Examples include walls, ceilings, mirrors.
Step 2: Determine the Total Risk Stratification Score:
The frequency of cleaning is based on the factors listed above. A score is given if the factors are present, and the frequency of cleaning is based on the total score as derived in the following matrix:
Appendix A Table 1. Risk Stratification Scores for High-Touch Surfaces
(Score for Potential for Exposure = 3)
| Probability of contamination with pathogens | More susceptible population (score = 1) | Less susceptible population (score = 0) |
|---|---|---|
| Heavy (score = 3) | Moderate (score = 2) | Light (score = 1) |
| 7 (3+3+1) | 6 (3+2+1) | 5 (3+1+1) |
| 6 (3+3+0) | 5 (3+2+0) | 4 (3+1+0) |
Appendix A Table 2. Risk Stratification Scores for Low-Touch Surfaces
(Score for Potential for Exposure = 1)
| Probability of contamination with pathogens | More susceptible population (score = 1) | Less susceptible population (score = 0) |
|---|---|---|
| Heavy (score = 3) | Moderate (score = 2) | Light (score = 1) |
| 5 (1+3+1) | 4 (1+2+1) | 3 (1+1+1) |
| 4 (1+3+0) | 3 (1+2+0) | 2 (1+1+0) |
Step 3: Determine the cleaning frequency based on the risk stratification matrix:
Cleaning frequencies for each patient care area are derived from the total score that results from the risk stratification matrix above.
Appendix A Table 3. Cleaning Frequencies Based on Total Risk Score
| Total Risk Score | Risk Type | Minimum Cleaning Frequency |
|---|---|---|
| 7 | High Risk | Clean after each case/event/procedure and clean additionally as required |
| 4–6 | Moderate Risk | Clean at least once daily Clean additionally as required (e.g., gross soiling) |
| 2–3 | Low Risk | Clean according to a fixed schedule Clean additionally as required (e.g., gross soiling) |
Appendix A Table 4. Patient Care Area Examples
| Location | Probability of Contamination | Potential for Exposure | Vulnerability of Population | Total Score | Minimum Cleaning Frequency |
|---|---|---|---|---|---|
| Burn Unit | 2–3 | 3 | 1 | 6–7 | Clean after each case/event/procedure, at least twice daily and clean additionally as required |
| General inpatient | 1–2 | 3 | 0 | 4–5 | Clean at least once daily and clean additionally as required |