Cleaning, decontamination and waste management

Understand how to maintain a clean environment.

Learning Outcome 1:

Learners should understand the meaning of environmental cleaning and the general principles surrounding this.

Environmental cleaning is a fundamental principle of infection prevention in healthcare settings. The outcome-based cleanliness standards have been developed using current best practice within the NHS. The outcome based standards offer:

• patient and customer focus;
• clarity for housekeeping staff and service providers
• an effective aid to management
• consistency with infection control standards and requirements; and
• clear outcome statements, which can be used as benchmarks and output indicators.

General Principles of Cleaning

In general, the following applies for all areas that provide care to individuals:

• Wash hands before and after all procedures and after removing gloves
• Cleaning where possible, should take place in a dedicated area away from patient care. Use a designated sink (not a hand wash basin)
• Equipment should be dismantled where necessary in line with the manufacturers’ instructions before cleaning
• A clean, disposable cloth should be used and discard immediately after use
• Use neutral detergent and warm water (maximum 42-43°C) for general cleaning Rinse thoroughly to remove detergent residue
• Dry thoroughly after cleaning using disposable towels or paper roll (where appropriate)
• If item visibly soiled with blood or body fluids clean first and then disinfect with a chlorine releasing agent (see section below on blood spillages)
• Wear protective clothing as appropriate
• Decontaminate any cleaning equipment after use e.g. bowl/bucket/sink
• A written cleaning schedule should be devised specifying the persons responsible for cleaning, the frequency of cleaning, and the expected outcomes. These schedules should be publicly displayed and followed
• Keep mops and buckets clean, dry and store inverted. Mop heads should be removable for laundering daily or disposable/single use
• Ensure colour coding, in line with the National Cleaning guidelines, is used for equipment used to clean, toilets, kitchens, general areas and isolation rooms
• Store cleaning equipment clean and dry between uses.

Colour coding of hospital cleaning materials and equipment ensures that these items are not used in multiple areas, therefore reducing the risk of cross-infection. These are:

Red: Toilets, Bathrooms, Shower rooms, Sluice Rooms

Blue: General Ward including ward and office areas

Green: Catering departments and Kitchen / Food preparation areas in the clinical environment

Yellow: Isolation areas

Assessment Criteria

• 1.1

  State the general principles for environmental cleaning.

• 1.2

  Explain the purpose of cleaning schedules.

• 1.3

  Describe how the correct management of the environment minimises the spread of infection.

• 1.4

  Explain the reason for the national policy for colour coding of cleaning equipment.

Understand the principles and steps of the decontamination process.

The learner should be aware of the three stages of the decontamination process: cleaning, disinfection and sterilisation and be able to describe each.

Cleaning: Cleaning is the process that physically removes contamination but does not necessarily destroy micro-organisms.

• It is essential used equipment is cleaned before disinfection in order for these processes to be effective.
• Equipment must be dried thoroughly after cleaning.

Disinfection: Disinfection is a process that destroys or reduces the numbers of harmful micro-organisms. This does not destroy bacterial spores.

• Chemical disinfectants may not work properly when they are:
• oUsed on dirty objects
• oNot freshly made up
• oMade up to the wrong concentration

Learners should be able to identify when cleaning agents should be used and how.

Chemical disinfectants must never be mixed with other cleaning products as this may produce toxic and other harmful gases.

All chemical agents used for cleaning and disinfection must have a suitable risk assessment under COSHH regulations. They must be stored, reconstituted and used in accordance with the manufacturer’s instructions.

Learners must be able to identify the role of personal protective equipment, for example to prevent or control the spread of infection, and why it is important to use it, including:

• gloves
• aprons
• gowns
• masks
• goggles
• face shields
• visors.

Learners should understand risk in relation to dealing with different types of contamination. The choice of decontamination method should be related to the infection risk associated with the intended use of the equipment. Other factors to be taken into consideration when choosing a method of decontamination include the nature of the contamination, the time required for processing, the heat, pressure, moisture and chemical tolerance of the object, the availability of the processing equipment and the quality and risks associated with the decontamination method.

Learners should be able to describe how equipment should be cleaned and stored. This should follow Standard Operating Procedures and manufacturers’ guidelines.

Assessment Criteria

• 2.1

  Describe the three steps of the decontamination process.

• 2.2

  Describe how and when cleaning agents are used.

• 2.3

  Describe how and when disinfecting agents are used.

• 2.4

  Explain the role of personal protective equipment (PPE) during the decontamination process.

• 2.5

  Explain the concept of risk in dealing with specific types of contamination.

• 2.6

  Explain how the level of risk determines the type of agent that may be used to decontaminate.

• 2.7

  Describe how equipment should be cleaned and stored.

Understand the importance of good waste management practice.

Learners should be able to identify the different types of waste and the risks associated with these. Clinical waste is defined as:

• a)“. . . any waste which consists wholly or partly of human or animal tissue, blood or other body fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles or other sharp instruments, being waste which unless rendered safe may prove hazardous to any person coming into contact with it; and
• b)any other waste arising from medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation, treatment, care, teaching or research, or the collection of blood for transfusion, being waste which may cause infection to any person coming into contact with it.”

Clinical waste can be divided into three broad groups of materials:

• a)any healthcare waste which poses a risk of infection
• b)certain healthcare wastes which pose a chemical hazard
• c)medicines and medicinally-contaminated waste containing a pharmaceutically-active agent.

The term offensive waste is defined within the Controlled Waste Regulations as waste that:

• c)is not clinical waste
• d)contains body fluids, secretions or excretions
• e)is classified under specific codes in the List of Wastes Regulations as follows:
• f)waste whose collection and disposal is not subject to special requirements in order to prevent infection
• g)other municipal (household or similar) separately collected fractions not otherwise specified (in this case used for offensive waste)

The waste will be classified as hazardous (with reference to the definition in the Hazardous Waste Regulations) if it contains or is contaminated with a dangerous substance at sufficient concentration to generate a hazardous property.

Learners should be aware of the importance of colour coding waste in line with the colour coding key to segregation system. This is to avoid any cross-contamination and infection.

Sharps found in the health care setting include hypodermic syringe needles, suture needles and scalpels. All sharps must be disposed of in suitable sharps receptacles and require assessment for the presence of medicines, such as cytotoxic or non-cytotoxic medicines. In practice, many health care organisations use a purple lidded sharps receptacle for cytotoxic/cytostatic sharps and yellow lidded sharps receptacles for all other sharps.

Health care staff working in the community are responsible for waste produced as a result of their activities. This means everyone who manages waste or has responsibility for waste (including the health care organisation) is required to fully comply with their duty of care. In summary, the community health care worker must first assess and classify the waste correctly - whether a used wound dressing is infectious or offensive waste, for example – and then ensure it is placed in the correct colour coded container, which is closed and labelled appropriately ready for removal or collection.

The safe management of health care waste manual suggests there are two main options for removing health care waste from a patient’s home. It can be stored safe and secure at the home owner’s premises in a place not accessible by children or animals (the householder must consent to the storage of the waste) until collected by a pre-arranged designated authority such as a waste management contractor. Alternatively, the health care worker can remove the items and transport back to their work base where there are consolidation facilities for collection and treatment/ disposal.

When transporting waste in their own vehicles, health care workers should ensure that they are transporting the waste in suitable United Nations (UN) approved rigid packaging that is fit for purpose and capable of safely and securely containing the goods (in other words, is leak proof). 

Assessment Criteria

• 3.1

  Identify the different categories of waste and the associated risks.

• 3.2

  Explain how to dispose of the different types of waste safely and without risk to others.

• 3.3

  Explain how waste should be stored prior to collection.

• 3.4

  Identify the legal responsibilities in relation to waste management.

• 3.5

  State how to reduce the risk of sharps injury.