I. Environmental and equipment decontamination
A. Environmental services personnel and CES personnel will be selected by the ES and CES administrations, respectively and be trained for cleaning and disinfecting EID patient rooms/units and in cleaning and disinfecting equipment attached to patients or used for patient care.
B. ES and CES personnel will use All Barrier Precautions (ABP) when cleaning in rooms/units where surfaces may be contaminated with the microorganism that causes the EID.
1. N-95 mask (fit tested)
2. Goggles
3. Gown
4. Gloves
C. ES and CES personnel will be fit tested for their N-95 masks and will be trained in donning and removing Personal Protective Equipment (PPE). ES and CES personnel who have not been fit tested for their N-95 mask will not be permitted to work in EID patient isolation rooms.
D. ES and CES personnel will be monitored daily for signs and symptoms of an EID after their last contact with an EID patient or an area contaminated by an EID patient. For SARS, ES and CES personnel will be monitored for 10 days after their last contact with a SARS or a possible SARS patient and for avian influenza, ES and CES personnel will be monitored for 7 days after their last contact with an avian influenza or a possible avian influenza patient.
1. ES and CES personnel should sign on the sign up form on the door of an EID patient’s room or a room from which an EID patient has just been discharged.
2. If no form is available at the site where ES and CES personnel are cleaning and disinfecting a contaminated room or equipment, ES and CES personnel should call the Department of Healthcare Epidemiology at 23192 to register every day they have contact with one or more EID patients or rooms contaminated by an EID patient.
E. Cleaning and disinfection in rooms occupied by EID patients.
1. Cleaning will be done using an EPA – registered hospital detergent-disinfectant.
2. Cleaning rooms on medical/surgical nursing units.
a. Cleaning of environmental surfaces will be done by ES and will be guided by a list of sites on a form that will be completed for each room cleaned. Sites cleaned will be those in the environment excluding surfaces of devices and equipment attached to the patient. All the sites cleaned will be checked off on the form and signed by the employee (See Appendix A).
b. Forms will be checked, approved and signed by the supervisor.
c. Clinical Equipment Services (CES) personnel will clean and decontaminate surfaces of devices and equipment attached to patients.
d. These CES personnel will be specially trained in this task and will use a check off list for each item to be decontaminated. The form with the check off list will be reviewed, approved and signed by their supervisor (Appendix B).
3. Cleaning rooms in intensive care units (ICUs).
a. Cleaning in ICUs by ES will be guided by a list of sites on a form. Sites cleaned will be those in the environment excluding surfaces of devices and equipment attached to the patient. Sites cleaned will be checked off on the form and signed by the employee (See Appendix C).
b. Forms will be checked, approved and signed by the supervisor.
c. CES personnel will clean and decontaminate surfaces of devices and equipment attached to patients.
d. These personnel will use a check off list for each item to be decontaminated. The form with the check off list will be reviewed, approved and signed by their supervisor (Appendix D).
4. Cleaning patient rooms and procedure rooms (e.g. bronchoscopy suite) after performance of high risk aerosolization procedures.
a. ES will be called to decontaminate environmental surfaces in rooms after a high risk procedure has been performed.
b. All Barrier Precautions (ABP) will be followed as for cleaning of patient rooms.
c. All horizontal surfaces and other surfaces in the room that may have become contaminated will be cleaned and disinfected.
F. Terminal cleaning of patient rooms.
1. ABP will be used by personnel doing terminal cleaning.
a. N-95 mask (fit tested)
b. Goggles
c. Gown
d. Gloves
2. All surfaces in the room should be cleaned with an EPA – registered detergent disinfectant following the list of sites on a check off form (Appendix E).
a. Mattresses and headboards should be wiped down with an EPA – approved hospital disinfectant.
b. For rooms with privacy curtains, the curtains should be removed, placed in a plastic bag in the room and double bagged into a laundry bag with the assistance of another member of the ES staff standing at the door outside the room. The person outside the door should wear an N-95 mask and gloves. After completing the task this person should remove gloves, wash hands with an antimicrobial soap and water or apply an alcohol gel to their hands. Then the mask should be removed taking care to avoid self contamination and then hand hygiene completed as above.
c. No cleaning of window curtains, ceiling or walls is necessary unless visibly soiled.
3. The check off form should be signed by the employee and approved by the supervisor.
G. Cleaning and removal of equipment from patient rooms after discharge of patients.
1. Wearing ABP PPE including 2 gowns and 2 pair of gloves, CES personnel will clean and disinfect the surfaces of all clinical equipment to be removed from the room.
2. After cleaning and disinfection, the first pair of gloves will be removed and the equipment to be taken to CES will be pushed to the door of the room.
3. The second pair of gloves, goggles and top gown will be removed.
4. The equipment will be pushed from the room.
5. Hands will be washed with an antimicrobial soap and water or an alcohol hand gel will be applied.
6. The N-95 mask will then be removed.
7. Hands will again be washed or an alcohol hand gel applied.
8. A new set of gloves will be donned.
9. Equipment will then be taken to CES using the elevator designated for EID patients.
II. Cleaning and Decontamination in the Negative Pressure Zone in the Emergency Department (ED)
A. ES administration will select two persons for cleaning and disinfection of examination rooms in the negative pressure zone in the ED.
B. These ES personnel will be trained to work safely and effectively in the negative pressure zone.
C. Personnel working in the negative pressure zone will wear All Barrier Precautions (ABP) personal protective equipment (PPE). They must be fit-tested for their N-95 masks.
1. N-95 mask
2. Goggles
3. Gown
4. Gloves
D. A cleaning cart will be dedicated to the area. It will be kept in the hall.
E. Cleaning Protocol
1. Cleaning materials will be taken from the cart into the room to be cleaned.
2. The door will be kept closed while the room is being cleaned.
3. The surfaces to be cleaned are listed on Appendix F. The surfaces cleaned must be checked off on the form and the form signed by the person doing the cleaning and by the supervisor.
4. When cleaning of a room has been completed, the door will be closed and the cleaning materials returned to the carts.
5. ES personnel must remain in the hall when waiting to clean the next vacant room. They must not enter the nursing station or other areas.
6. ES personnel need only to change gloves between rooms. Gloves should be removed so as to avoid touching the outside of the gloves.
7. Hands should be washed with an antimicrobial soap and water or an alcohol gel applied to the hands prior to donning a new set of gloves.
F. ES personnel must register their name on a form and include contact information so that they may be contacted daily by the Employee Health Service to check on temperature and symptoms of an EID.
