Safe management of the care environment

The care environment must be:

  • visibly clean, free from non-essential items and equipment to facilitate effective cleaning
  • well maintained, in a good state of repair and with adequate ventilation for the clinical

Equipment used for environmental decontamination must be either single-use or dedicated to the affected area then decontaminated or disposed of following use eg cloths, mop heads.

Environmental decontamination: enhanced cleaning

Hospital setting:

Patient isolation/cohort rooms/area must be decontaminated at least daily, this may be increased on the advice of Infection Prevention and Control Team (IPCTs). These areas must be decontaminated using either:

  • a combined detergent/disinfectant solution at a dilution of 1,000 parts per million available chlorine (ppm available chlorine (av.cl.)); or
  • a general-purpose neutral detergent in warm water followed by solution of 1,000ppm cl.

Alternative cleaning agents/disinfectant products may be used with agreement of the local IPC team.

Employers must ensure that cleaning products are managed in accordance with the COSHH regulations – Control of substances hazardous to health (COSHH) – health and safety topics in cleaning.

Manufacturers’ guidance and recommended product ‘contact time’ must be followed for all cleaning/disinfection solutions.

Increased frequency of decontamination/cleaning schedules should be incorporated into the environmental decontamination schedules for areas where there may be higher environmental contamination rates, eg:

  • toilets/commodes particularly if patients have diarrhoea; and
  • “frequently touched” surfaces eg door/toilet handles, locker tops, over bed tables and bed rails.

Vacated rooms should also be decontaminated following an aerosol generating procedure (AGP). Clearance of infectious particles after an AGP is dependent on the ventilation and air change within the room. This is a minimum of 20 minutes in hospital settings where the majority of these procedures occur. In general wards and single rooms there should be a minimum of 6 air changes per hour, in negative-pressure isolation rooms there should be a minimum of 10 air changes per hour. Advice should be sought from IPCT.

Primary care/outpatient settings:

The extent of decontamination between patients will depend on the duration of the consultation/assessment, the patients presenting symptoms and any visible environmental contamination.

Terminal decontamination

Following patient transfer, discharge, or once the patient is no longer considered infectious, remove from the vacated isolation room/cohort area, all:

  • healthcare waste and any other disposable items (bagged before removal from the room)
  • bedding/bed screens/curtains – manage as infectious linen (bagged before removal from the room)
  • reusable non-invasive care equipment (decontaminated in the room prior to removal) Appendix

The room should be decontaminated using either:

  • a combined detergent disinfectant solution at a dilution (1,000ppm cl.); or
  • a general-purpose neutral detergent in warm water followed by a solution of 1,000ppm av.cl. (or alternative locally agreed cleaning product)

Rooms must be cleaned from highest to lowest points and from least to most contaminated points.

Organisations can consider using Hydrogen Peroxide Vapour disinfection or ultra- violet light technology for specific pathogens. Manufacturers’ guidance and recommended product “contact time” must be followed for all cleaning/disinfection solutions.

There is no requirement for terminal cleaning of outpatient/theatre recovery unless advised by the IPCT.

Manual contents

Introduction
Chapter 1: Standard infection control precautions (SICPs)

Chapter 2: Transmission based precautions (TBPs)

Appendices

Download a PDF copy of the National infection prevention and control manual for England