Key Definitions & Abbreviations

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.

a substance that prevents or arrests the growth or action of microorganisms by inhibiting their activity or by destroying them. The term is used especially for preparations applied topically to living tissue.

Automatic dispensing system:
systems that provide computer controls (automation) for preparation of cleaning or disinfectant solutions. These systems replace the need for manually measuring a quantity of cleaning or disinfectant products and water.

Chemical-resistant gloves:
gloves that protect the hands from chemicals. They can be made latex or another manufactured material, such as nitrile, and can be water- or liquid-proof.

Chemical sterilant:
an agent that is applied to inanimate objects or heat-sensitive devices to kill all microorganisms and bacterial spores.

the physical removal of foreign material (e.g., dust, soil) and organic material (e.g., blood, secretions, excretions, microorganisms). Cleaning physically removes rather than kills microorganisms. It is accomplished with water, detergents, and mechanical action.

Cleaning cart (also known as cleaning trolley):
a dedicated cart or trolley that carries environmental cleaning supplies and equipment, in addition to bags or bins for soiled materials, such as laundry, for disposal or reprocessing.

Cleaning products (also known as cleaning agents):
liquids, powders, sprays, or granules that remove organic material (e.g., dirt, body fluids) from surfaces and suspend grease or oil. Can include liquid soap, enzymatic cleaners, and detergents.

Cleaning session:
a continuous environmental cleaning activity performed over a defined time period in defined patient care areas. A cleaning session could include routine or terminal cleaning.

Cleaning solution:
a combination of water and cleaning product (e.g., detergent) in a ratio specified by the manufacturer.

Contact time:
the time that a disinfectant must be in contact with a surface or device to ensure that appropriate disinfection has occurred. For most disinfectants, the surface should remain wet for the required contact time.

the presence of any potentially infectious agent on environmental surfaces, clothing, bedding, surgical instruments or dressings, or other inanimate articles or substances, including water, medications, and food.

Critical patient care equipment:
equipment and devices that enter sterile tissue or the vascular system, such as surgical instruments, cardiac and urinary catheters.

a synthetic cleansing agent that can emulsify and suspend oil. Contains surfactant or a mixture of surfactants with cleaning properties in dilute solutions to lower surface tension and aid in the removal of organic soil and oils, fats, and greases.

Disinfectant fogging:
misting or fogging a liquid chemical disinfectant to disinfect environmental surfaces in an enclosed space.

a thermal or chemical process for inactivating microorganisms on inanimate objects.

Chemical compounds that inactivate (i.e., kill) pathogens and other microbes and fall into one of three categories based on chemical formulation:

  • low-level
  • mid-level
  • high-level

Disinfectants are applied only to inanimate objects. All organic material and soil must be removed by a cleaning product before application of disinfectants. Some products combine a cleaner with a disinfectant.

Disinfectant solution:
a combination of water and disinfectant, in a ratio specified by the manufacturer.

Dry sweeping:
using a broom to clean dry floors.

Dry mopping:
using a dry mop to clean dry floors.

Environmental cleaning:
cleaning and disinfection (when needed, according to risk level) of environmental surfaces (e.g., bed rails, mattresses, call buttons, chairs) and surfaces of noncritical patient care equipment (e.g., IV poles, stethoscopes).

Environmental cleaning services area:
a dedicated space for preparing, reprocessing, and storing clean or new environmental cleaning supplies and equipment, including cleaning products and PPE. Access is restricted to cleaning staff and authorized personnel.

Focal person:
a person who serves as a coordinator or focal point of information concerning an activity or program.

General patient areas:
outpatient or ambulatory care wards and inpatient wards with patients admitted for routine medical procedures who are not receiving acute care (i.e., sudden, urgent or emergent episodes of injury and illness that require rapid intervention).

Hand hygiene:
any action of hand cleansing to physically or mechanically remove dirt, organic material or microorganisms.

Hemodialysis station:
a hemodialysis machine with a chair or bed and connections to purified water and sanitary sewer. Stations in facilities with central delivery can also have acid concentrate and bicarb concentrate connections.

High-level disinfection:
kills all microorganisms, with the exception of small numbers of bacterial spores.

High-touch surfaces:
surfaces, often in patient care areas, that are frequently touched by healthcare workers and patients (e.g., bedrails, overbed table, IV pole, door knobs, medication carts).

Incubator (also known as isolette):
a self-contained unit that provides a controlled heat, humidity, and oxygen microenvironment for the isolation and care of premature and low-birth weight neonates.

Low-level disinfection:
inactivates most vegetative bacteria, some fungi, and some viruses in a practical contact time, but does not kill more hardy viruses (e.g. non-enveloped), bacterial genus (e.g. mycobacteria), or bacterial spores.

Low-touch surfaces:
surfaces that are minimally touched by healthcare workers and patients (e.g., walls, ceilings, floors).

Material compatibility:
the chemical compatibility and other factors that affect corrosion, distortion, or other damage to materials.

Mechanical action:
the physical action of cleaning—includes rubbing, scrubbing, and friction.

Microfiber cloths:
cloths made from a tightly woven combination of polyester and polyamide (nylon) fibers.

Mid-level disinfection (also intermediate-level disinfection):
kills inactivate vegetative bacteria, including mycobacteria, most viruses, and most fungi, but might not kill bacterial spores.

Multidrug-resistant organisms (MDRO) and pathogens:
germs (viruses, bacteria, and fungi) that develop the ability to defeat the drugs designed to kill them. Typically refers to an isolate that is resistant to at least one antibiotic in three or more drug classes.

Noncritical patient care equipment:
equipment, such as stethoscopes, blood pressure cuffs and bedpans, that comes into contact with intact skin.

Patient care areas:
any area where patient care is directly (e.g., examination room) and indirectly (e.g., medication preparation area) provided. Includes the surrounding healthcare environment (e.g., patient toilets).

Patient zone:
the patient and his or her immediate surroundings. Includes all surfaces that are temporarily and exclusively designated for that patient.

Personal protective equipment (PPE):
clothing or equipment worn by staff to protect themselves against hazards (e.g., blood or body fluids).

Private vs. shared toilets:
private toilets are dedicated to one person over a specified time period—environmental cleaning always takes place before their use by a different person. Shared toilets are used by more than one person within a specified time period and might not be cleaned before use by a different person.

the process of cleaning and disinfecting a device or piece of equipment for reuse on the same patient (e.g., hemodialyzers) or other patients.

Resource-limited settings:
settings with insufficient individual or societal resources—human, financial, or technological—to support a robust public healthcare system.

Reusable rubber gloves (also referred to as domestic gloves or household gloves):
gloves that protect the hands from liquids, including cleaning or disinfectant solutions, and chemicals. They are stronger (more durable) than disposable (single use) latex gloves.

Routine cleaning:
the regular cleaning (and disinfection, when indicated) when the room is occupied to remove organic material, reduce microbial contamination, and provide a visually clean environment. Emphasis is on surfaces within the patient zone.

Safety data sheet (SDS):
a document by the supplier or manufacturer of a chemical product that contains information on the product’s potential hazards (health, fire, reactivity, and environmental) and how to work safely with it. It also contains information on the use, storage, handling, and emergency procedures.

Scheduled cleaning:
cleaning (and disinfection, when indicated) that occurs concurrently with routine cleaning and aims to reduce dust and soiling on low-touch surfaces.

Semi-critical patient care equipment:
equipment, such as endoscopes, respiratory and anesthesia equipment, and vaginal ultrasound probes, that comes into contact with mucus membranes.

Sluice room:
a dedicated room or area, separated into dirty and clean areas, where noncritical patient care equipment is reprocessed. Access is restricted to cleaning staff and authorized personnel.

Specialized patient areas:
inpatient wards or units (e.g., medication preparation areas) for high-dependency patients (e.g., ICUs), immunosuppressed patients (e.g., bone marrow transplant, chemotherapy), patients undergoing invasive procedures (e.g., operating rooms), or those who are regularly exposed to blood or body fluids (e.g., labor and delivery ward, burn units).

Standard Precautions:
are used for all patient care. Based on a risk assessment and make use of common sense practices and personal protective and other equipment that protects healthcare providers from infection and prevent the spread of infection from patient to patient.

Surgical field:
includes the patient zone in the operating rooms where asepsis is required. Only sterile objects and personnel are allowed in the surgical field.

Terminal (discharge) cleaning:
cleaning and disinfection after the patient is discharged or transferred. Includes the removal of organic material and significant reduction and elimination of microbial contamination.

Three-bucket system (mopping):
floor mopping system for cleaning and disinfection. One bucket contains a detergent or cleaning solution, the second bucket contains disinfectant or disinfectant solution, and the third bucket contains clean water for rinsing the mop.

Transmission-Based Precautions:
are used in addition to Standard Precautions for patients with known or suspected infections. There are three categories:

  • Contact:
    intended to prevent transmission of infectious agents, including epidemiologically important microorganisms, that are spread by direct or indirect contact with the patient or the patient’s environment
  • Droplet:
    intended to prevent transmission of pathogens spread through close respiratory or mucous membrane contact with respiratory secretions
  • Airborne:
    intended to prevent transmission of infectious agents that remain infectious over long distances when suspended in the air (e.g., rubeola virus [measles], varicella virus [chickenpox], M. tuberculosis, and possibly SARS-CoV)

For some diseases that have multiple routes of transmission (e.g., SARS), more than one Transmission-Based Precautions category can be used.

Transport equipment:
wheelchairs, trolleys, stretchers, and other portable equipment used to transport patients.

Two-bucket system (mopping):
floor mopping system for cleaning only (not disinfection). One bucket contains a detergent or cleaning solution and the second bucket contains clean water for rinsing the mop.

a machine used to clean and disinfect reusable patient care equipment (e.g., bedpans, urine bottles and bowls) and pre-clean reusable minor surgical instruments before sterilization.



Abbreviations and Terms
Abbreviation Term
ATP Adenosine tri-phosphate
CDC Centers for Disease Control and Prevention
C. diff Clostridioides difficile
GRADE Grading of Recommendations, Assessment, Development and Evaluation
HAI Healthcare-associated infection
HEPA High-Efficiency Particulate Air
ICAN Infection Control Africa Network
ICU Intensive Care Unit
IPC Infection Prevention and Control
MRSA Methicillin-resistant Staphylococcus aureus
OR Operating Room
PPE Personal Protective Equipment
SOP Standard Operating Procedure
SDS Safety Data Sheet
UNICEF United Nations International Children’s Emergency Fund
VRE Vancomycin-resistant Enterococci
WASH Water, Sanitation and Hygiene
WASH FIT Water and Sanitation for Health Facility Improvement Tool
WHO World Health Organization