GUIDELINE ESSENTIALS

QUICK VIEW
Environmental Cleaning

• Do not use disinfectants (eg, phenolics) to clean

infant bassinets or incubators while these items are
occupied. If disinfectants are used to terminally clean
infant bassinets or incubators, prepare solutions in the
correct concentrations per the manufacturer’s IFU and
rinse treated surfaces with water.
• Prepare, handle, use, store, and dispose of cleaning
chemicals in accordance with manufacturers’ IFU and
local, state, and federal regulations.
• If the cleaning chemical is removed from the original
container, immediately label the secondary container with
the chemical name, concentration, and expiration date.
• Make the safety data sheets available for each
cleaning chemical.
• Conduct an annual chemical-hazard risk assessment of
all cleaning chemicals in use.
• Remove visible soil from a surface before applying a
disinfectant.
• Do not use a spray bottle to apply disinfectants; use
a cloth or pour disinfectants onto environmental
PRODUCT SELECTION AND USE surfaces in a manner that prevents splashing.
• Select disinfectants for use in the perioperative setting • Use low-linting cleaning materials (eg, mop heads, cloths).
based on the following factors: • Do not use a broom with bristles to sweep the floor in
-- Environmental Protection Agency (EPA) registration the semi-restricted or restricted areas.
and hospital-grade rating • Dedicate cleaning materials, tools, and equipment for
-- targeted organisms use only in restricted and semi-restricted areas.
-- contact times • Before storage and reuse, disassemble cleaning
-- manufacturers’ instructions for use (IFU) equipment according to the manufacturers’ IFU, then
-- compatibility with surfaces, cleaning materials, and clean, disinfect with an EPA-registered disinfectant,
equipment and dry the equipment.


-- patient population A standardized product selection process
-- cost assists in the selection of functional and
-- safety reliable products that are safe, cost-effective, and
-- effect on the environment environmentally preferable and that promote quality
• Do not use high-level disinfectants or liquid chemical care, as well as decreases duplication or rapid
sterilants to clean and disinfect environmental surfaces obsolescence. Effective cleaning and disinfection is
or noncritical devices. accomplished when the correct tools and equipment
• Do not use alcohol to disinfect large environmental are paired with the correct chemicals, and are used
surfaces (eg, tables, OR bed). according to the manufacturer’s IFU.

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 • Clean and disinfect equipment that is stored outside
the surgical suite before bringing it into the semi-
restricted area.
• Remove and replace damaged or worn mattress
coverings and padded positioning devices.

 Cleaning an area in a methodical pattern

establishes a routine for cleaning so that items
are not missed during the cleaning process. Even in
the best scenario, the floor is essentially contaminated
as soon as it is cleaned because of new contaminants
introduced by air currents or traffic. Nonintact
surfaces may become reservoirs for microorganisms
CLEANING PROCEDURES
and may harbor pathogens.
• Use standard precautions when cleaning to prevent
contact with blood, other body fluids, or other
potentially infectious materials.
• Identify high-touch objects and surfaces to be cleaned
and disinfected.
• Determine the frequency and extent of cleaning required
when areas are not occupied (eg, unused rooms).
• Perform cleaning activities in a methodical pattern.
• When cleaning with the same cleaning material (eg,
cloth, wipe, mop head), progress from clean to dirty
and top to bottom, including when damp dusting.
• Do not return cleaning materials to the cleaning
solution container.
BETWEEN-PATIENT CLEANING
• Change reusable cleaning materials after each use.
• Damp dust all horizontal surfaces (eg, furniture, surgical
Discard disposable cleaning materials after each use
lights, booms, equipment) with a clean, low-linting cloth
according to the manufacturer’s IFU.
moistened with a disinfectant before the first scheduled
• Clean and disinfect items that contact the floor per the surgical or other invasive procedure of the day.
manufacturer’s IFU.
• Damp dust before case carts, supplies, and equipment are
• Mop floors in semi-restricted and restricted areas with a brought into the room.
damp or wet mop. Do not dust the floor with a dry mop.
• Clean and disinfect ORs after each patient procedure.
• Mop from the cleanest to the dirtiest areas of the floor.
• Do not begin environmental cleaning, including trash and
• After each patient use, clean and disinfect reusable, contaminated laundry removal, until the patient has left the
noncritical, nonporous surfaces such as mattress OR or procedure room.
covers, pneumatic tourniquets, blood pressure
• Remove trash and used linen from the room.
cuffs, and other patient equipment according to the
manufacturer’s IFU. • Clean and disinfect all items used during patient care:
-- anesthesia carts, including the top and drawer handles
• Discard single-use items after each patient use.
-- anesthesia equipment (eg, IV poles, IV pumps)
• Apply a protective barrier covering to noncritical
-- anesthesia machines, including dials, knobs, and valves
equipment surfaces if the surface cannot withstand
disinfection or is difficult to clean (eg, computer -- patient monitors, including cables
keyboards, foot pedals, touchscreen computer -- OR beds
monitors). Remove or clean and disinfect the cover -- reusable bed attachments (eg, arm boards, stirrups,
after use per the manufacturer’s IFU. head rests)

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 -- positioning devices -- positioning devices
-- patient transfer devices (eg, roll boards) -- patient transfer devices
-- overhead procedure lights -- overhead procedure lights
-- tables and Mayo stands -- tables and Mayo stands
-- mobile and fixed equipment -- mobile and fixed equipment

• Clean and disinfect the floor with a mop after each -- storage cabinets, supply carts, and furniture
surgical or invasive procedure when the floor is visibly -- light switches
or potentially soiled by blood or other body fluids (eg, -- door handles and push plates
splash, splatter, a dropped item). -- telephones and mobile communication devices
• Spot clean and disinfect the walls after each surgical or -- computer accessories (eg, keyboard, mouse, touch
invasive procedure when the walls are visibly soiled. screen)
-- chairs, stools, and step stools

 Dust is known to contain human skin and

hair, fabric fibers, pollens, mold, fungi, insect
parts, glove powder, and paper fibers, among
-- trash and linen receptacles
• Clean and disinfect the entire floor, including areas
other components. In settings with dry conditions, under the OR bed and mobile equipment, using either
gram-positive cocci (eg, coagulase-negative a wet vacuum or mop.
Staphylococcus species) found in dust may persist;
in settings with surfaces that are moist and soiled,
gram-negative bacilli may persist.
 Terminal cleaning is thorough environmental
cleaning performed at the end of each day
the room or area is used. It is not necessary to
perform terminal cleaning or close the OR after a
contaminated or dirty/infected procedure (ie, Class
III, Class IV). Enhanced environmental cleaning
should be performed if the patient is infected with a
multidrug-resistant organism (MDRO).

PREOPERATIVE AND POSTOPERATIVE AREAS

• Clean preoperative and postoperative areas after
each patient has left the area.
• Clean and disinfect items that are used during patient
care, including:
-- patient monitors
-- infusion pumps and IV poles
TERMINAL CLEANING -- patient beds and stretchers
• Terminally clean operating and procedure rooms each -- over-bed tables
day the rooms are used. -- televisions remote controls
-- call lights
• Clean and disinfect the exposed surfaces, including
• Clean and disinfect mobile and fixed equipment used
wheels and casters, of all items:
during patient care.
-- anesthesia carts, including the top and drawer handles
• Clean and disinfect the floor with a mop when the floor
-- anesthesia equipment is visibly soiled or potentially soiled by blood or other
-- anesthesia machines, including dials, knobs, and valves body fluids.
-- patient monitors, including cables • Spot clean and disinfect the walls when the walls are
-- OR beds visibly soiled.
-- reusable table straps • Terminally clean the preoperative and postoperative
-- OR bed attachments patient care areas each day the areas are used.

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• Clean and disinfect the exposed surfaces, including • Avoid terminal cleaning while personnel are actively
wheels and casters, of all items in the area: decontaminating instruments.
-- patient monitors • Clean and disinfect all work surfaces and high-touch
-- patient beds or stretchers objects in the clean work areas and decontamination
-- over-bed tables areas using a clean, low-linting cloth.
-- television remote controls • Remove trash from receptacles at least daily and when
-- call lights they are full.
-- mobile and fixed equipment • Clean and disinfect all floors in sterile processing areas
-- storage cabinets and supply carts each day the areas are used.
-- furniture
-- light switches
-- door handles and push plates
 Dust or debris on surfaces can be aerosolized onto
sterilized items or instruments being prepared
for sterilization. Damp dusting and terminally cleaning
-- telephones and mobile communication devices sterile processing areas daily helps to minimize the
-- computer accessories opportunity for dust dispersal. Sterile processing areas
-- chairs, stools, and step stools have some of the highest risks for environmental
-- trash and linen receptacles contamination of all perioperative areas.
• Clean and disinfect the entire floor, including areas under
mobile equipment, using either a wet vacuum or mop.

 Cleaning of the preoperative and postoperative

areas after each patient has left the area is a
regulatory requirement of the Centers for Disease
Control and Prevention and the Centers for
Medicare & Medicaid Services.

SCHEDULED CLEANING
• Clean areas and equipment that are not terminally
cleaned on a schedule (eg, weekly, monthly), including:
-- clean and soiled areas
-- sterile storage area
-- shelving, drawers, and storage bins
-- corridors, including stairwells and elevators
STERILE PROCESSING AREAS -- walls and ceilings
• Damp dust all horizontal surfaces in the sterilization -- privacy curtains
packaging area (eg, countertops, workstations) at least -- pneumatic tubes and carriers
daily with a clean, low-linting cloth moistened with a -- sterilizers and loading carts
disinfectant.
-- sterilizer service access rooms
• Terminally clean sterile processing areas each day the -- lounges, waiting rooms, locker rooms, bathrooms,
areas are used. and offices
• Clean and disinfect the clean work areas (eg, the -- environmental services closets
packaging area, the sterile storage area) before the -- ventilation ducts, including vents and grilles
dirty work areas (eg, the decontamination area). -- linen chutes

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 -- refrigerators and ice machines • Use an EPA-registered disinfectant that is effective
-- sinks and eye wash stations against C difficile spores after caring for a patient


diagnosed with or suspected of infection or
Areas and equipment that are not cleaned
colonization with Candida auris.
according to a schedule may be missed
during routine cleaning procedures and become • Restrict room access following the care of a patient
environmental reservoirs for dust, debris, and diagnosed with or suspected of infection with an
microorganisms. airborne transmissible disease (eg, tuberculosis) and
following aerosolization activities (eg, intubation,
extubation, cough-generating activities) of a patient
diagnosed with or suspected of infection with a
droplet transmissible disease (eg, influenza) until
adequate time has passed for air exchanges per hour
to remove 99% of airborne particles from the air (eg,
15 air exchanges per hour for 28 minutes to remove
99.9% of airborne contaminants).

• Wear respiratory protection (eg, an N95 respirator)

to perform environmental cleaning if entering the
room before a complete air exchange occurs.

 Enhanced environmental cleaning is the

cleaning of surfaces that extends beyond
routine cleaning and is performed following the care
of a patient who is infected or colonized with an
ENHANCED CLEANING MDRO. Decreasing environmental contamination on
high-touch surfaces may decrease the risk of MDRO
• Follow enhanced environmental cleaning procedures
transmission.
after caring for patients who are known or suspected
to be infected or colonized with an MDRO or other
significant pathogens.
• Clean and disinfect all items touched during patient
care, including:
-- storage cabinets, supply carts, and furniture
-- light switches
-- door handles and push plates
-- telephones and mobile communication devices
-- computer accessories
-- chairs, stools, and step stools
-- trash and linen receptacles
-- privacy curtains in the perioperative patient care areas

• In addition to using standard precautions, wear

a gown and gloves when performing enhanced
environmental cleaning procedures.
• Use an EPA-registered disinfectant that is effective CONSTRUCTION/REMEDIATION
against Clostridioides difficile spores after caring for • Implement cleaning and disinfection procedures for
patients diagnosed or suspected of infection with C construction, renovation, repair, demolition, and
difficile. disaster remediation.

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• Perform cleaning and disinfection of environmental • If surfaces are damaged or cannot dry within 72
surfaces to remove dust and debris. hours, perform remediation to replace the surface
with new materials after the facility engineer
• If dust is contaminating areas outside of the
determines that the underlying structure is dry.
construction barriers, assess the barriers to
determine their effectiveness before starting any • Perform terminal cleaning of affected areas when
construction project. condensation is observed on surfaces.
• When contamination of the incoming air occurs,
• Perform terminal cleaning before equipment
perform terminal cleaning of the affected areas,
and supplies are placed in the area where the
including ventilation ducts, air vents, and grilles,
construction, renovation, repair, demolition, or
and change air filters after the source of the
disaster remediation has been completed.
contamination is identified and contained.


• If flooding or a water-related emergency occurs,
Determine the cleaning and disinfection
including sewage intrusion, inspect the area for water
procedures and frequencies during
damage and implement a cleaning and disinfection
construction, renovation, repair, demolition, and
process.
disaster remediation based on an infection-control
• When surfaces remain in good repair, allow them to risk assessment performed by an interdisciplinary
dry for 72 hours and then perform terminal cleaning. team that includes an infection preventionist.

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All rights reserved. Used with permission.