Appendix B2 – Cleaning procedure summaries for specialized patient areas

Best Practices for Environmental Cleaning in Global Healthcare Facilities with Limited Resources

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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.

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Operating room

These are high-risk specialized patient areas with a mechanically controlled atmosphere where surgical procedures are performed. A high degree of asepsis is required because the vulnerability of the patients to infection is high.

Appendix B2 Table 1. Cleaning Procedure Summaries for Operating Room

Cleaning Procedure Summary for Operating Room by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Before first procedure Shared cleaning possible: perioperative nursing/clinical staff and cleaning staff Disinfect:
  • horizontal surfaces
    • furniture
    • surgical lights
    • operating bed
    • stationary equipment
 See 4.6.1 Operating rooms

 

Records of previous evening terminal clean required; if not or if no surgeries on the day prior, perform terminal clean (as below)
Before and after every procedure Shared cleaning possible: perioperative nursing/clinical staff and cleaning staff Clean and disinfect:
  • high-touch surfaces (e.g., light switches, doorknobs) outside surgical field
  • any surface visibly soiled with blood or body fluids
  • all surfaces and noncritical equipment and the floor inside the surgical field
 See 4.6.1 Operating rooms

 

Remove all used linen and surgical drapes, waste (including used suction canisters, ¾ filled sharps containers), and kick buckets, for reprocessing or disposal

Portable noncritical (e.g., compressed gas tanks, x-ray machine) equipment should be thoroughly cleaned and disinfected before and after each procedure
After last procedure (terminal clean) Shared cleaning possible: perioperative nursing/clinical staff and cleaning staff Clean and disinfect:
  • all surfaces and noncritical equipment in the operating room
  • the entire floor
  • any surface visibly soiled with blood or body fluids
  • scrub and utility areas/sinks
 See 4.6.1 Operating rooms

 

Carefully move the operating table and any mobile equipment to make sure that the floor areas underneath are thoroughly cleaned and disinfected

Clean and disinfect low-touch surfaces, (e.g., the insides of cupboards and ceilings/walls) on a scheduled basis (e.g., weekly)
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Medication preparation areas

Areas where medication is prepared (including pharmacy or in clinical areas) are high-risk areas in which high degree of asepsis is required.

Appendix B2 Table 2. Cleaning Procedure Summaries for Medication Preparation Areas

Cleaning Procedure Summary for Medication Preparation Areas by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Between uses Clinical staff Clean and disinfect:
  • countertops
  • portable carts used to transport or prepare medications
 None
End of each day Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • all high-touch surfaces
  • floors
 Clean and disinfect low-touch surfaces, such as the tops of shelves and walls/vents, on a scheduled basis (e.g., weekly)
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Sterile services areas

Areas where semi-critical and critical equipment is sterilized and stored in which high degree of asepsis is required.

Appendix B2 Table 3. Cleaning Procedure Summaries for Sterile Services Areas

Cleaning Procedure Summary for Sterile Services Areas by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Before and after every use Clinical staff Clean and disinfect:
  • utility sinks used for washing
  • semi-critical equipment (e.g., endoscopes)
 None
Twice daily Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • all high-touch surfaces
    • countertops
    • surfaces of washing equipment
    • handwashing sinks
  • floors
 Clean and disinfect low-touch surfaces, such as the tops of shelves and walls/vents, on a scheduled basis (e.g., weekly) during the final daily clean
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ICU (adult, pediatric, neonatal)

These are high-risk areas because patients may be immuno-compromised by underlying diseases, treatment modalities (e.g., invasive devices) and other life-threatening conditions (e.g., major trauma, stroke) and vulnerability to infection is high.

Appendix B2 Table 4. Cleaning Procedure Summaries for ICU (adult, pediatric, neonatal)

Cleaning Procedure Summary for ICU by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Twice daily and as needed Cleaning staff Clean and disinfect:
  • high-touch surfaces (only outside of neonatal incubator when occupied)

Clean:

  • floors with neutral detergent and water
 Last clean of the day: clean low-touch surfaces.
At discharge / transfer (terminal clean) Cleaning staff Clean and disinfect:
  • high-touch surfaces
  • low-touch surfaces
  • floors
  1. Remove soiled/used personal care items (e.g., cups, dishes) for reprocessing or disposal.
  2. Remove facility-provided linens for reprocessing or disposal.
  3. Inspect window treatments. If soiled, clean blinds on-site, and remove curtains for laundering.
  4. Reprocess all reusable (noncritical) patient care equipment.
  5. Clean and disinfect all low- and high-touch surfaces, including those that may not be accessible when the room/area was occupied (e.g., patient mattress, bedframe, tops of shelves, vents), and floors.
  6. Clean (scrub) and disinfect handwashing sinks.

Pay special attention to terminal cleaning of incubators.

Change filters in incubators according to manufacturer’s instructions, when wet or if neonate was on contact precautions (during terminal clean).
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Special isolation units

These are high-risk areas in which patients are highly immunosuppressed (e.g., bone marrow transplant, leukemia) and vulnerability to infection is high.

Appendix B2 Table 5. Cleaning Procedure Summaries for Special Isolation Units

Cleaning Procedure Summary for Special Isolation Units by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Daily, before cleaning any other patient care area (i.e., first cleaning session of the day) Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • high-touch surfaces, with focus on the patient zone

Clean:

  • floors with neutral detergent and water
 In addition, clean low-touch surfaces
At discharge / transfer (terminal clean) Cleaning staff Clean and disinfect:
  • high-touch surfaces
  • low-touch surfaces
  • floors
  1. Remove soiled/used personal care items (e.g., cups, dishes) for reprocessing or disposal.
  2. Remove facility-provided linens for reprocessing or disposal.
  3. Inspect window treatments. If soiled, clean blinds on-site, and remove curtains for laundering.
  4. Reprocess all reusable (noncritical) patient care equipment.
  5. Clean and disinfect all low- and high-touch surfaces, including those that may not be accessible when the room/area was occupied (e.g., patient mattress, bedframe, tops of shelves, vents), and floors.
  6. Clean (scrub) and disinfect handwashing sinks.
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Burn units

These are high-risk units where vulnerability of the patients to infection (immunocompromised) and probability of contamination (e.g., with blood and body fluids) are high.

Appendix B2 Table 6. Cleaning Procedure Summaries for Burn Units

Cleaning Procedure Summary for Burn Units by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Before and after (i.e., between) every procedure and twice daily and as needed Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • high-touch surfaces and floors, focus on the patient zone
  • any surface visibly soiled with blood or body fluids
 Remove soiled linens and waste containers for disposal/reprocessing

Last clean of the day: clean and disinfect entire floor and low-touch surfaces
At discharge / transfer (terminal clean) Cleaning staff Clean and disinfect:
  • high-touch surfaces
  • low-touch surfaces
  • entire floor
  1. Remove soiled/used personal care items (e.g., cups, dishes) for reprocessing or disposal.
  2. Remove facility-provided linens for reprocessing or disposal.
  3. Inspect window treatments. If soiled, clean blinds on-site, and remove curtains for laundering.
  4. Reprocess all reusable (noncritical) patient care equipment.
  5. Clean and disinfect all low- and high-touch surfaces, including those that may not be accessible when the room/area was occupied (e.g., patient mattress, bedframe, tops of shelves, vents), and the entire floor.
  6. Clean (scrub) and disinfect handwashing sinks.
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General procedure areas

These are high-risk areas (such as radiology and endoscopy services) because they often service patients with high vulnerability to infection (e.g., immunosuppressed), in addition to other patient populations.

Appendix B2 Table 7. Cleaning Procedure Summaries for General Procedure Areas

Cleaning Procedure Summary for General Procedure Areas by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Before and after every procedure Clinical staff Clean and disinfect:
  • any surface that is visibly soiled with blood or body fluids
  • high-touch surfaces inside the patient zone
    • procedure table/station
    • counter tops
    • external surfaces of fixed equipment
  • floors inside the patient zone
 Remove disposable equipment and reprocess reusable noncritical patient care equipment; see 4.7 Noncritical patient care equipment
After last patient of the day (terminal clean) Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • all high-touch and low-touch surfaces
  • entire floor
 Move the procedure table and other portable equipment to clean and disinfect the entire floor area

Handwashing sinks should be thoroughly cleaned (scrubbed) and disinfected
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Labor and delivery wards/rooms

These are high-risk areas because they are routinely contaminated and vulnerability of patients to infection is high.

Appendix B2 Table 8. Cleaning Procedure Summaries for Labor and Delivery Wards/Rooms

Cleaning Procedure Summary for Labor and Delivery Wards/Rooms by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Before and after (i.e., between) every procedure Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • any surface that is visibly soiled with blood or body fluids
  • high-touch surfaces inside the patient zone
  • floor inside the patient zone
 Remove soiled linens and waste containers for disposal/reprocessing
After last delivery of the day (terminal clean) Cleaning staff Clean and disinfect:
  • any surface that is visibly soiled with blood or body fluids
  • all high-touch and low-touch surfaces
  • entire floor
 Move the procedure table and other portable equipment to clean and disinfect the entire floor area

 

Handwashing sinks should be thoroughly cleaned (scrubbed) and disinfected
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Hemodialysis stations/areas

These are high-risk areas because they are routinely contaminated and vulnerability of patients to infection is high.

Appendix B2 Table 9. Cleaning Procedure Summaries for Hemodialysis Stations/Areas

Cleaning Procedure Summary for Hemodialysis Stations/Areas by Frequency, Staff, Product, and Description.
Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
After each event/case Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • any surface that is visibly soiled with blood or body fluids
  • all surfaces of the dialysis station area
    • bed
    • chair
    • countertops
    • external surfaces of the machine
  • floor inside the patient zone
 Remove disposable patient care items/waste and reprocess reusable patient care equipment per below

 

Carefully allow enough contact time before the next subsequent use of the station/area
After last case of the day (terminal clean) Cleaning staff Clean and disinfect:
  • any surface that is visibly soiled with blood or body fluids
  • all surfaces of the dialysis station/area
  • high-touch surfaces in the area/room housing hemodialysis stations
  • entire floor
 Move the procedure table and other portable equipment to clean and disinfect the entire floor area

 

In addition, clean low-touch surfaces on a scheduled basis (e.g., weekly)
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Pediatric outpatient area

These are high risk areas because they are frequently contaminated and pediatric patients are more vulnerable to infection due to pathogens such as enteric viruses and influenza.

Appendix B2 Table 10. Cleaning Procedure Summaries for Pediatric Outpatient Area

Cleaning Procedure Summary for Pediatric Outpation Area by Area, Frequency, Staff, Product, and Description.
Area Description Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Waiting/admission areas At least daily and as needed (e.g., visibly soiled, blood/body fluid spills) Cleaning staff Clean and disinfect:
  • high-touch surfaces
  • low-touch surfaces
  • floors
 Toys that may be put into mouth of infant or toddler must be cleaned, disinfected and rinsed thoroughly after each use
Consultation/examination areas After each event/case and at least twice per day and as needed Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • high-touch surfaces
 Last clean of the day: clean and disinfect the entire floor and low-touch surfaces
Minor operative procedure rooms Before and after (i.e., between) every procedure Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • any surface visibly soiled with blood or body fluids
  • high-touch surfaces in the patient zone
  • floors in the patient zone
 Last clean of the day: clean and disinfect:
  • other high-touch surfaces and low-touch surfaces
  • handwashing sinks<
  • scrub/sluice areas
  • the entire floor
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Emergency department

These are moderate to high-risk areas because of the number of people who could contaminate the environment and because some patients may be more susceptible to infection (e.g., trauma patients).

Appendix B2 Table 11. Cleaning Procedure Summaries for Emergency Department

Cleaning Procedure Summary for Emergency Department by Area, Frequency, Staff, Product, and Description.
Area Description Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Waiting/admission areas At least daily and as needed (e.g., visibly soiled, blood/body fluid spills) Cleaning staff Clean and disinfect:
  • high-touch surfaces
  • low-touch surfaces
  • floors
 None
Consultation/examination areas After each event/case and at least twice per day and as needed Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • high-touch surfaces
 Last clean of the day: clean and disinfect the entire floor and low-touch surfaces
Procedure areas include trauma areas for high acuity patients Before and after (i.e., between) every procedure Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:
  • any surface visibly soiled with blood or body fluids
  • high-touch surfaces in the patient zone
  • floors in the patient zone
 Last clean of the day: clean and disinfect:
  • other high-touch surfaces and low-touch surfaces
  • handwashing sinks
  • scrub/sluice areas
  • the entire floor
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Transmission-based precaution/Isolation wards

These are high risk areas, especially for environmentally hardy pathogens (e.g., resistant to disinfectants) and for multidrug-resistant pathogens that are highly transmissible or are associated with high morbidity and mortality.

Appendix B2 Table 12. Cleaning Procedure Summaries for Transmission-Based Precaution / Isolation Wards

Cleaning Procedure Summary for Transmission-Based Precaution/Isolation Wards by Area, Frequency, Staff, Product, and Description.
Area description Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Airborne precautions Daily and as needed Cleaning staff Clean (neutral detergent and water):
  • high-touch surfaces
  • floors
 Primary focus is adherence to required PPE and additional entry/exit procedures; see Table 5

 

In addition, clean low-touch surfaces on a scheduled basis (e.g., weekly)
Droplet and/or contact precautions Twice daily and as needed Cleaning staff Clean and disinfect:
  • any surface visibly soiled with blood or body fluids
  • high-touch surfaces
  • floors
 Cleaning staff must wear required PPE Table 5

 

Dispose of or reprocess cleaning supplies and equipment immediately after cleaning.

Last clean of the day: clean and disinfect low-touch surfaces
Patient diagnosed with C. difficile on droplet and contact precautions Twice daily and as needed Cleaning staff Clean and disinfect (two-step process required and sporicidal agent):
  • any surface visibly soiled with blood or body fluids
  • high-touch surfaces in the patient zone
  • floors
 Two-step process required (do not use combined detergent-disinfectant):
  1. Rigorous mechanical cleaning process (e.g., using friction).
  2. Disinfectant with sporicidal properties, for example:
    • sodium hypochlorite solution (e.g., 1,000-5,000ppm)
    • enhanced hydrogen peroxide at 4.5%
Dedicated noncritical patient care equipment for patients on transmission-based precautions Consistent with cleaning frequency for patient zone, before and after each use and as needed Shared cleaning possible: (clinical staff and cleaning staff) Products based on the risk level of the patient care area Select a compatible disinfectant; see 4.7.1 Material compatibility considerations

 

Reprocess (i.e., clean and disinfect) dedicated equipment after patient is discharged or transferred (terminal clean)

Conduct terminal cleaning of all noncritical patient care equipment in 4.7.2 Sluice rooms
All transmission-based precautions At discharge / transfer (terminal clean) Cleaning staff; conducted in close collaboration with clinical staff, specifically unit manager or shift leader, who should coordinate schedule Clean and disinfect:
  • high-touch surfaces
  • low-touch surfaces
  • floors
  1. Remove soiled/used personal care items (e.g., cups, dishes) for reprocessing or disposal.
  2. Remove facility-provided linens for reprocessing or disposal.
  3. Always remove privacy curtains and window coverings for laundering (curtains, blinds).
  4. Reprocess all reusable (noncritical) patient care equipment in sluice rooms.
  5. Clean and disinfect all low- and high-touch surfaces, including those that may not be accessible when the room/area was occupied (e.g., patient mattress, bedframe, tops of shelves, vents), and floors.
  6. Clean (scrub) and disinfect handwashing sinks.

Airborne precautions:

Cleaning staff must wear required PPE; see Table 5.

Keep the door closed during the environmental cleaning process (ventilation requirement).
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Noncritical patient care equipment

These items are high-touch surfaces that are touched by both patients and by healthcare workers and may be used on multiple patients. They include portable or stationary noncritical patient care equipment such as IV poles, commode chairs, blood pressure cuffs, wheelchairs and stethoscopes.

Appendix B2 Table 13. Cleaning Procedure Summaries for Noncritical Patient Care Equipment

Cleaning Procedure Summary for Noncritical Patient Care Equipment by Area, Frequency, Staff, Product, and Description.
Area Description Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Shared equipment (including transport equipment – e.g., wheelchairs) -shared between patients Before and after every patient, and as needed Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:

Select a compatible disinfectant; see 4.7.1 Material compatibility considerations

 Ensure division of cleaning responsibility between nursing and cleaning staff

 

Clean and disinfect heavily soiled items (e.g., bedpans) in 4.7.2 Sluice rooms

Disinfect bedpans with a washer-disinfector or boiling water instead of a chemical disinfection process
Dedicated equipment – when dedicated to a particular patient during their stay Consistent with cleaning frequency for patient area, and as needed Shared cleaning possible: (clinical staff and cleaning staff) Products based on the risk level of the patient care area Ensure division of cleaning responsibility between nursing and cleaning staff
Shared and dedicated equipment At patient discharge/transfer Shared cleaning possible: (clinical staff and cleaning staff) Clean and disinfect:

Select a compatible disinfectant; see 4.7.1 Material compatibility considerations

 Conduct terminal cleaning of all noncritical patient care equipment in dedicated 4.7.2 Sluice rooms
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Spills of blood or body fluids

Regardless of the risk-level of an area, spills or contamination from blood or body fluid (e.g., vomitus) must be cleaned and disinfected immediately using a two-step process.

Appendix B2 Table 14. Cleaning Procedure Summaries for Spills of Blood or Body Fluids

Cleaning Procedure Summary for Spills of Blood or Body Fluids by Area, Frequency, Staff, Product, and Description.
Area Description Frequency Person/Staff Responsible Products/Technique Additional Guidance/Description of Cleaning
Any spill in any patient or non-patient area Immediately, as soon as possible Cleaning staff
  1. Wear appropriate PPE; see Table 5.
  2. Confine the spill and wipe it up immediately with absorbent (paper) towels, cloths, or absorbent granules (if available) that are spread over the spill to solidify the blood or body fluid (all should then be disposed as infectious waste).
  3. Clean (neutral detergent and water).
  4. Disinfect using a facility-approved intermediate-level disinfectant.
  5. Immediately reprocess all reusable supplies and equipment (e.g., cleaning cloths, mops) after the spill is cleaned up.
 Mark off spill area to prevent contact
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