effective environmental decontamination during covid 19 ......effective environmental...

Effective Environmental Decontamination During COVID-19 Standard Operating Procedures

Reference Number: NCAE057(20) Version: 1 Issue Date: 17/12/2020 Page 1 of 26

It is your responsibility to check on the intranet that this printed copy is the latest version


Lead Author: Louise Simpson, Group Senior Nurse, Estates & Facilities

Paula Challoner, Group Cleaning Lead Training and

Compliance

Division/ Department:: Estates & Facilities

Applies to: Bury & Rochdale Care Organisation

North Manchester Care Organisation

Oldham Care Organisation

Salford Royal Care Organisation

Approving Committee: Clinical Advisory Group

Date approved: 11/12/2020

Review date: 11/12/2025

Contents

Contents

Section Page

1 Overview 2

2 Scope & Associated Documents 2

3 Background 2

4 What is new in this version? 2

5 Procedure 2

6 Roles and responsibilities 22

7 Monitoring document effectiveness 22

8 Abbreviations and definitions 23

9 References 23

10 Document Control Information 24

11 Equality Impact Assessment (EqIA) tool 25

Group arrangements:

Salford Royal NHS Foundation Trust (SRFT)

Pennine Acute Hospitals NHS Trust (PAT)




1. Overview (What is this procedure about?) Effective environmental decontamination plays a vital role in limiting the transmission of COVID-19, as it reduces the presence of the virus and the risk of contact. Decontamination is a combination of processes, cleaning, disinfection and/or sterilisation. This Standard Operating Procedure (SOP) has been developed to provide guidance and consistent methodology for effective environmental decontamination for clinical areas, non-clinical areas, lifts, patient transport vehicles, community staff vehicles during the COVID-19 pandemic.

2. Scope (Where will this document be used?)

Reducing clutter and removing difficult to clean items makes cleaning easier. During the pandemic, cleaning frequencies should be increased for both environmental and equipment in all areas, in particular frequently touched sites/points. This SOP can be implemented by staff, specific to their working environment. If required, additional training will be offered to undertake effective environmental decontamination. Staff should wear a Fluid Repellent Surgical Mask (FRSM) at all times in all internal areas and if required appropriate additional PPE. Adequate hand hygiene must also be performed and maintain social distancing >2metres at all times.

3. Background (Why is this document important?)

Keeping the working environment clean and clutter free is everyone’s responsibility, including domestics, facilities, nursing, allied health professionals and non-clinical staff. Cleaning and decontaminating the healthcare environment should routinely form part of providing care practices, additional to the routine daily cleaning throughout the 24 hour care period. During the pandemic, to reduce the spread additional high touch point cleaning is recommended in non-clinical areas, for example workshops, offices, laboratories, kitchens and staff rest areas.

4. What is new in this version?

This procedure is replacing Pennine Acute Hospitals NHS Trust EDE018 Trust cleaning and is a new procedure for Salford Royal NHS Foundation Trust.

5. Procedure Cohorted Cleaning Practice Domestic staff should be allocated (cohorted) to specific area(s), and not move between non COVID-19 (low risk pathway), suspected COVID-19 (medium risk pathway) and COVID-19 (high risk pathway) clinical areas. It is important to note, patients on various risk pathways, may be being care for within the same ward/clinical environment. The order in which cleaning schedules should be undertaken is:

1. Carry out cleaning to non COVID-19 areas (low risk pathway)




2. Suspected COVID-19 patient isolation rooms or clinical rooms (medium risk pathway)

3. Finally, confirmed COVID -19 patient areas, ideally at the end of shift (high risk pathway)

Cleaning Levels All clinical areas receive a standard Level 1A/2A clean as least once per day. If additional cleaning requests are required they should be requested as below.

Non COVID-19 Areas (Low Risk Pathway)

Level 1A Standard daily clean of an occupied bed space / bay / ward using a chlorine based product.

Level 1B Standard clean following patient move or discharge of an occupied bed space using

chlorine based product.

Suspected COVID-19 Areas (Medium Risk Pathway) or other known Infection

Level 2A Standard daily clean of an occupied bed space / bay/ ward with a known outbreak or infection using chlorine based solution. This will be completed at the end of shift to prevent nosocomial transmission, but prior to confirmed COVID-19 areas (High risk pathway).

Level 2B Terminal environmental decontamination following a patient transfer or discharge using chlorine based solution with a known outbreak or infection. This includes wall washing and curtain change.

Level 3A Not indicated for COVID-19.

Following Level 2B clean, decontamination with Hydrogen Peroxide Vapour (HPV) “fogging” following patient transfer or discharge with known infection or outbreak of C-Difficile, Carbapenemase Producing Enterobacteriaceae (CPE), Norovirus, Salmonella and Campylobacter. This will be requested by Infection Prevention Control Team.

Level 3B Following Level 2B clean, following patient transfer or discharge with suspected COVID-

Low Risk Pathway

No COVID

Medium Risk Pathway

Suspected COVID

High Risk Pathway

Confirmed COVID




19, decontaminate with Ultra Violet C (UVC). (Not suitable for ward bays unless empty)

Confirmed COVID-19 Areas (High Risk Pathway) or following an outbreak in a Non-

Clinical Area

Level 2A Standard daily clean of an occupied bed space / bay/ ward/ non-clinical area with a known outbreak or infection using chlorine based solution. This will be completed at the end of shift to prevent nosocomial transmission.

Level 2B Terminal environmental decontamination following a patient transfer or discharge using chlorine based solution with a known outbreak or infection. This includes wall washing and curtain change.

Level 3A Not indicated for COVID-19.

Following Level 2B clean, decontamination with Hydrogen Peroxide Vapour (HPV) “fogging” following patient transfer or discharge with known infection or outbreak of C-Difficile, Carbapenemase Producing Enterobacteriaceae (CPE), Norovirus, Salmonella and Campylobacter. This will be requested by Infection Prevention Control Team.

Level 3B Following Level 2B clean, following patient transfer or discharge with confirmed COVID-19, decontaminate with Ultra Violet C (UVC). (Not suitable for ward bays unless empty)

Personal Protective Equipment (PPE) The recommended level of PPE is determined by Public Health England (PHE) approved by Health and Safety Executive (HSE) and Medicines and Healthcare products Regulatory Agency (MHRA). Current national guidance should be applied at all times. General Environmental Decontamination – No risk of Aerosol Generated Procedures (AGPs) Recommended PPE for daily or terminal (following transfer or discharge) environmental decontamination of isolated side rooms / patient bays /non-clinical areas for both suspected and confirmed COVID-19 patients;

Disposable gloves

Fluid-Resistant Surgical Mask (FRSM)

Disposable Apron

Eye protection (visor/goggles)

Critical Care Areas / risk of Aerosol Generated Procedures (AGPs) Domestic staff who have been appropriately trained, working to latest national/organisational guidance to undertake daily and terminal environmental decontamination cleaning practice within critical care areas, where patients are potentially undergoing Aerosol Generating Procedures (AGP’s). Should be directed by clinical staff to determine when it is deemed appropriate to enter a room without a FFP3 respirator and surgical gown. However, if not required, standard PPE must still be worn at all times.




Level 1 & 2 Daily and Terminal Cleaning for all clinical areas with cases of suspected and

confirmed COVID-19 patients

Patient isolation rooms, cohort bays and clinical areas where suspected and confirmed COVID-19 patients are being cared for must be decontaminated at least daily. An increased frequency in decontamination processes should be incorporated where there may be higher environmental decontamination rates and the high touch points/frequently touched surfaces such as door handles, locker tops, patient tables, bed rails etc. should be cleaned at least four times per day or when known to be contaminated with bodily fluids. Environmental Decontamination Process Preparation Equipment required:

Chlorine solution

Yellow hand bucket

Yellow disposable cloths

Yellow mop bucket

Yellow mop stale

Yellow disposable traditional mops

Flat mop stale

Disposable flat mops

Dust pan and brush with nylon bristles (must be cleanable with chlorine)

Clinical waste bags

Clinical waste ties

Soap

Hand towels

Toilet tissue

Preparing chlorine solution:

1. Wash hands

2. Put on PPE – apron, gloves

3. Ensure the area is well ventilated

4. Check COSHH Data on product label

5. Check chlorine product is in date

6. Using you diluter, fill with cold water up to the two litre line

7. Place two chlorine tablets into the cold water

8. Allow tablets to dissolve, this will take approximately 9 – 12 minutes

9. Gently mix diluted product, but do not shake

The product is now ready for use.




Before entering a side room, patient bay or treatment room, ensure all equipment is available and adequate chlorine solution is prepared. Following preparation of equipment and chlorine solution, before applying PPE, ensure hands hygiene is adequately performed. Commencing the clean Note: prior to commencing the clean, pre–soak all your required cloths and mops in chlorine solution. Transfer all your required equipment into isolated room / patient bay:

1 flat mop stale

1 traditional mop stale

Pre-soaked cloths

Pre-soaked traditional mops

Pre-soaked disposable flat mops

Clinical waste bags

Clinical waste ties

Sanitary cleaner – Evans / PVA toilet cleaner

Hand towels

Toilet tissue

Soap

Extra PPE, Gloves / Apron

Environmental Decontamination Methodology

1. Dispose of several hand towels from both top and bottom of the towels in dispenser into

the clinical waste bag

2. Walls, if visibly stained, use a fresh pre-soaked disposable cloth, wipe stain several times

until it has disappeared

3. Repeat this process on all wall surfaces with visible stains, until they have been removed

4. Place the used disposable cloth into the clinical waste bag for disposal

5. If there are cleanable window blinds in room, using a pre-soaked disposable flat mop,

wash each individual slat, commencing at the top, and working your way down to the

bottom, ensuring both sides have been cleaned thoroughly

6. Place the used disposable flat mop in clinical waste bag for disposal

7. If the isolation area has a window, using a fresh pre-soaked disposable cloth wipe clean

the entire surface of the window, and buff dry with a clean dry cloth

8. Place the used disposable cloth in clinical waste bag for disposal

9. Using a fresh pre-soaked disposable cloth commence to clean all vertical and horizontal

elements in the isolation area, using a fresh pre-soaked disposable cloth for each

element. These elements to include where applicable:

Windowsills

Patient chair




Electrical trunking

Wall sockets

Light switches

Waste receptacles

Hand towel dispensers – inside and out

Soap dispensers – inside and out

Mirrors

Splash backs

Hand wash basin – start from underneath, thoroughly wiping down all pipework,

work up towards underside of basin, wash thoroughly. Top side of hand wash

basin, wash taps and inside of the basin.

Bed Frame Cleaning Note: use a fresh pre-soaked cloth for each step.

1. Starting with the headrest, wipe clean entire area, using long, overlapping sweeping

motion to ensure all areas have been cleaned thoroughly


3. Wipe clean the entire area of the foot rest, using long, overlapping sweeping motion to

ensure all areas have been cleaned thoroughly


5. Wipe clean all bed frame, starting at top and working down toward base of bed, paying

attention to the hard to reach areas


7. Extend hand rails on both sides of bed, wash all areas thoroughly, paying attention to

the undersides


9. Hand controls, wipe along coiled wire in one continuous sweeping action, ensuring the

entire wire has been wiped clean. Wipe hand control back, front and all sides, and place

on hand rail.


Process for Sanitary Decontamination Note: use a fresh pre-soaked cloth for each step.

1. Dispose of several hand towels from both top and bottom of the towels in dispenser into

the clinical waste bag

2. Remove soap from dispenser, wash inside and outside of dispenser, wash outer

packaging of soap and return to dispenser. Replace soap as and when required

3. Any visible marks to be removed from walls by using a fresh pre-soaked disposable

cloth, sweep over the mark, using an overlapping motion, repeat until mark has been

removed

4. Place the used disposable cloth into the clinical waste bag for disposal




5. If there are cleanable window blinds in room, using a pre-soaked disposable cloth, wash

each individual slat, commencing at the top, and working your way down to the bottom,

ensuring both sides have been cleaned thoroughly


7. If the isolation area has a window, using a fresh pre-soaked disposable cloth wipe clean

the entire surface of the window, and buff dry with a clean dry cloth


Fixtures and Fittings Note: use a fresh pre-soaked cloth for each step. Using a fresh pre-soaked disposable cloth commence to clean all vertical and horizontal elements in the isolation area, following the chronological order they are written, using a fresh pre-soaked disposable cloth for each element. These elements to include where applicable:

Apply cleaning solution inside toilet pan. Leave for contact time

Windowsills

Radiator/s and or radiator covers

Hand rails

Shower rails

Door and frame

Mirror

Hand towel dispenser from inside to out

Soap dispenser from inside to out

Splash back (hand wash basin)

Pipework

Underside of hand wash basin to the inside

Taps

Shower, including shower head

Shower tray

Bath

Remove several layers of the exposed toilet paper

Toilet roll holder, from inside to out.

Splash back toilet

Waste receptacles

W.C. working your way from the base of the pedestal up to the basin

W.C seat underside and top

Flush

Door handles




Floor Cleaning

1. Using a dry disposable flat mop, commencing at the edge of the furthest point away from

the door, using a sweeping, overlapping figure of eight motion, walking backwards,

sweep entire floor surface.

2. At end of task, place all debris into clinical waste bin, including mop.

3. Using yellow disposable traditional mop, pre-soaked with chlorine solution, and

commence at the edge of the furthest point in the room away from the door, using a

sweeping, overlapping figure of eight motion, walking backwards towards the door, damp

mop entire surface of the floor.

4. Upon mop drying out, dispose and replace with a fresh disposable mop, soaked in

chlorine solution.

5. Place all used disposable mops in clinical waste bag for disposal.

Repeat this process for the floor in side room or Bay. End of task

1. Check the area is visibly clean

2. Check to ensure all consumable items have been replenished

3. Check to ensure all disposable items, including those used for cleaning have been

removed

4. Check mops stales have been washed thoroughly with chlorine solution prior to being

removed from the room

5. Check dust pan has been washed thoroughly with chlorine solution prior to being

removed from the room

6. Following terminal clean after patient discharged or transferred, advise clinical staff

environmental decontamination completed

Before leaving the room

1. Remove PPE by removing gloves first, and wash hands

2. Remove gown, rolling and folding in on itself away from the body

3. Wash hands thoroughly

4. Remove disposable mask by breaking ties at back, only hold the ties, lean slightly

forward and remove entire mask

5. Place in clinical waste bin

6. Thoroughly wash hands

7. Put on fresh gloves and apron and transport all clinical waste to secure clinical waste bin

in waste disposal area

Waste disposal

1. All clinical waste bags must be sealed at three quarters full, DO NOT overfill

2. Do not compress waste bags

3. ‘Swan neck’ the bags




4. Cable ties or tape must be used to seal the bag

5. The initial bag must be placed inside a second clinical waste bag, and a second cable tie

or tape used to seal this bag

6. Clinical waste bags should then be placed in a secure clinical waste bin in waste disposal

area

ClearSCREENS Transparent Curtains Decontamination Process Scope This is applicable to all domestic staff trained in the application of appropriate PPE and the methodology to undertake decontamination of ClearSCREENS upon patient discharge. Indication

Clear Screen Decontamination Process follows a Level 1B clean. For decontamination of

ClearSCREENS following a Level 2B clean, follow procedures below, changing the colour

coded cloth from blue to yellow.

Preparation Equipment required:

Chlorine solution

Blue disposable cloths for Level 1 cleans

Yellow disposable cloths for Level 2 cleans

Mop bucket

Flat mop stale


Hazard warning signs


1. Wash hands

2. Put on PPE – gloves and apron

3. Ensure the area is well ventilated

4. Check COSHH Data on product label

5. Check chlorine product is in date

4 Using you diluter, fill with cold water up to the two litre line

5 Place two chlorine tablets into the cold water

6 Allow tablets to dissolve, this will take approximately 9 – 12 minutes

7 Gently mix diluted product, but do not shake

The product is now ready for use.




Before entering a patient bay, ensure all equipment is available and adequate chlorine solution is prepared. Following preparation of equipment and chlorine solution, before applying PPE, ensure hands hygiene is adequately performed. Clear Screen Decontamination Methodology – for curtain facing vacated bed space

1. Pre-soak flat mop in chlorine solution

2. Position hazard warning signs so they are visible but not causing obstruction

3. Extend clear screen

4. Starting in the top hand corner closest to the wall, place your mop flat against the clear

screen

5. Using one long continuous stroke, move flat mop along top edge of clear screen to

opposite corner

6. Using long, overlapping continuous strokes, sweep your flat mop back towards wall

7. Continue with point 6 until the entire clear screen has been wiped clean with the chlorine

solution

8. Replace mop should it become soiled or dry,

9. Place the used disposable flat mop in clinical waste bag for disposal

10. Taking a pre-soaked disposable cloth, wipe systematically up one side of clear screen

edge, across the top, down the opposite edge and along the bottom, ending at you

starting point.

11. Place used disposable cloth in clinical waste bag for disposal

12. Take a clean dry disposable cloth and gently wipe across the entire surface of the clear

screen

13. Place used disposable cloth in clinical waste bag for disposal

14. Check floor for any spillages, wipe dry if required

End of task

1. Check all water marks have been removed from clear screen

2. Check there are no spillages on floor

3. Remove all equipment to designated store room

NB: it is deemed best practice to utilise disinfectant wipes to clean the high touch points

on the clear screen after each visit to bed space.

Decontaminating Frequent High Touch Point Surfaces within Healthcare Environment

Patient isolation rooms, cohort areas and clinical rooms where suspected and confirmed

COVID-19 patients are being cared for must be fully decontaminated at least daily. An

increased frequency in decontamination processes should be incorporated where there may be

higher environmental contamination rates and the ‘frequently touched’ surfaces such as door

handles, locker tops, patient tables, bed rails etc. High touch point cleaning should be routinely

performed at least four times within a 24 hour period or before or after specific points of care.




Hand Hygiene & Personal Protective Equipment (PPE)

To support effective high touch point surface cleaning, staff and patients should perform

effective hand hygiene practices and if appropriate and safe to do so apply hand alcohol gel.

Appropriate level of PPE should be worn; ensuring staff are trained in correct methods of

wearing, removing and disposing PPE. Hand hygiene must be performed and PPE changed

when moving between patient side rooms, clinical rooms or cohorted patient bays.

High Touch Point Surface Cleaning Method

Whilst wearing appropriate PPE, high touch points should be cleaned using chlorine solution,

and a clean cloth for each element, disposed in clinical waste bag.

Immediate patient care area

General high touch point surface decontamination is required four times daily:

Bedrails and frame

Over bed-table

Chair

Locker

Nurse call/entertainment system/bed control panels

IV pole grab area

Specific point of care high touch point surface decontamination is required before or after:

• Clean/aseptic procedures are performed including AGP’s

• Bodily fluid or respiratory secretion exposure/risk

• Placing food/drink on an over-bed table

• Patient bathing (within bed space)

• An item coming into contact with the floor

General healthcare environment

High touch point surfaces within sanitary areas, additional decontamination is required four

times daily:

Hand towel dispenser

Hand soap dispenser

Hand alcohol gel dispenser

Taps and hand wash basin

Toilet flush handle

Toilet roll dispenser

Door handles

Pull cord




Documentation, Audit and Monitoring Processes

High touch point cleaning schedules must be documented and audited for compliance. Cleaning

monits will continue to be completed weekly. Nursing documentation should reference high

touch point cleaning has been completed before and after point of care.

Lift cleaning following patient transfer with Suspected / Confirmed COVID-19

When patient and transfer team exit the lift, before lift is returned to public operation, all touch

points and floor must be cleaned thoroughly using chlorine solution.

PPE required when completing lift clean:

Disposable gloves

Disposable apron


Eye/face protection – full face visor or goggles

Touch points include:

Lift call button

Lift internal buttons

Hand rails

Floor cleaning:

Mop floor using a pre-soaked flat mop, then mop dry with a flat mop.

If required apply hazard warning sign

Equipment required:

Chlorine solution of 1,000 ppm

Disposable cloths

Mop stale

Disposable/re-useable flat mop heads x 2

Orange clinical waste bag

Hazard warning sign


Wash hands

Put on PPE – apron, gloves risk assess for eye protection

Ensure the area is well ventilated

Check COSHH Data on product label

Check chlorine product is in date

Using you diluter, fill with cold water up to the one litre line

Place one chlorine tablet into the cold water

Allow tablet to dissolve, this will take approximately 9 – 12 minutes

Gently mix diluted product, but do not shake

Upon completion dispose of used cloth and disposable mops or return re-useable mop for re-

processing.




Doffing PPE

Remove gloves

Remove apron

Wash hands

Remove eye/face protection

Remove FRSM

Wash hands

Non-Clinical Areas

Purpose This Standard Operating Procedure (SOP) has been developed to provide guidance and consistent methodology for effective environmental decontamination for daily cleans additional to any established scheduled service cleans by Domestic Services.

Scope This SOP is applicable to all clinical and non-clinical staff, working to the latest organisational guidance to undertake additional environmental decontamination cleaning in all non-clinical areas, to include but not exhaustive:

Staff rooms

Kitchens

Office spaces

Workshops

Laboratories

Roles and Responsibilities Keeping the working environment clean and clutter free is everyone’s responsibility. Domestic Service Manager is responsible for ensuring that the daily scheduled clean is completed in accordance with the agreed work schedule. All Clinical and non-clinical staff are responsible to ensure that they complete regular enhanced cleaning throughout the day, of all high touch points which they come into contact with. If any clinical or non-clinical member of staff experience difficulties implementing this SOP or have any concerns, they should immediately report to their line manager. Environmental Decontamination Process: Staff rooms / kitchens Equipment required:

PPE – Disposable gloves




Disinfectant wipes

General Purpose Detergent

High touch points in a staff room:

Door handle

Fridge door handle

Kettle – including plug and socket

Microwave

Toaster – including plug and socket

Worktops

Chair

Table

Remote control (if applicable)

Crockery & cutlery

Shared locker (if applicable)

Bin

Methodology: Wash hands thoroughly and put on disposable gloves. Note: Using a disinfectant wipe, commence to clean all vertical and horizontal surfaces, using a new disinfectant wipe for each element. Use one long stroke to capture all sides, as indicated below. Dispose of disinfectant wipe immediately after use.

Door handle – Wrap your disinfectant wipe around all sides of handle, with one sweep

clean both the outside and inside

Fridge door handle – As above

Kettle – including plug and socket – Using your wipe, place around all sides of handle on

kettle, pull wipe downwards. Using a fresh wipe, remove lid and wipe both side

thoroughly. Using a fresh wipe, ensure the switch is in the off position, remove plug from

wall, wipe clean all side of casing, paying attention not to dampen the prongs. Wipe clean

the wall socket.

Microwave - Wrap your disinfectant wipe around all sides of handle, with one sweep

clean both the outside and inside. Using a fresh wipe clean thoroughly the controls. After

use, remove the turntable plate and wash in warm water and general detergent. Wipe

clean the inside of microwave.

Toaster – including plug and socket – Using your wipe, wipe clean the outside of the

toaster, paying particular attention to the lever for lowering your toast. Using a fresh wipe,




ensure the switch is in the off position, remove plug from wall, wipe clean all side of

casing, paying attention not to dampen the prongs. Wipe clean the wall socket.

Worktops – Using a fresh wipe, clean along all edges, capturing any edges, and using

long, overlapping strokes complete the cleaning of the entire worktop surface. Replace

wipe as and when necessary.

Chair – Wipe down all sides of chair, commencing at the back rest, seat, and pay

particular attention to the arm rests, these must be wiped top, bottom and sides if

applicable.

Table – Always wipe clean with a fresh wipe, work your way around the edge of the table

top, then infill the middle using long, overlapping strokes, until all table surface has been

cleaned.

Remote control (if applicable) – wrapping your wipe around entire remote control, wipe

clean the entire surface

Crockery & cutlery – All crockery and cutlery used must be washed thoroughly in warm

water and general detergent. Best practice is to have your own crockery and cutlery,

which you can store away in between uses.

Shared locker (if applicable) – Locker fronts should be wiped clean every time used,

and also at the beginning and end of each day, before you store your belongings in them

and when you remove your belongings.

Bin – Wipe the entire surface of the bin lid, to include sides and edges. Always operate

the bin by using the foot pedal where available.

Note: Do not share newspapers or magazines. Any used items MUST be disposed of in waste. Environmental Decontamination Process: Office Spaces

Equipment required:

PPE – Disposable gloves

Disinfectant wipes

High touch points in an Office area:

Door handles

Keyboard

Keyboard wrist rest

Mouse

Mouse hand rest

Desk tops




Telephone

Stationary cupboard

Drawers

Photocopier

Printer

Bin

Methodology: Wash hands thoroughly and put on disposable gloves. Note: Using a disinfectant wipe, commence to clean all vertical and horizontal elements using a new disinfectant wipe for each element. Use one long stroke to capture all sides, as indicated below. Dispose of disinfectant wipe immediately after use.

Door handles – Wrap your disinfectant wipe around all sides of handle, with one sweep

clean both the outside and inside. Repeat this process each time you enter / exit the

office

Keyboard – Tilt the keyboard on his front, tap back of keyboard lightly to remove any

excess debris from in between the keys. Wipe clean the entire surface of the keyboard,

starting with the keys, then sides and back

Keyboard wrist rest – Wrap your wipe around wrist rest and using one long sweep wipe

clean the entire area. Repeat as required to ensure the whole surface has been

captured.

Mouse – Place mouse inside wipe and ensure all sides are cleaned thoroughly

Mouse hand rest – repeat as with mouse

Desk tops – Remove as many items as possible to do so from the desk top, or push to

one side. Starting from edges, wipe clean ensuring you capture the underside as you

work your way around. Wipe clean the middle of the desk by using long over lapping

strokes. Complete the entire surface

Telephone – Lift handset, cup wipe around one end, working your way upwards, wipe

clean the entire surface. With a fresh wipe, pull wipe along the coiled cable, starting

nearest to the handset, down to the telephone unit. Using a fresh wipe, starting on the

top of the unit where the digits are, wipe clean the entire surface, repeat for sides and

bottom of telephone.

Stationary cupboard – Each time you open the stationary cupboard, you will be

responsible to wipe clean the door handle. Using a fresh wipe, clean the entire handle,

top and underside.




Drawers – Wrap your disinfectant wipe around all sides of handle, with one sweep clean

both the outside and inside.

Filing cabinets – Each time you open the stationary cupboard, you will be responsible to

wipe clean the door handle. Using a fresh wipe, clean the entire handle, top and

underside.

Photocopier/Printer – Each time you use the photocopier, it is your responsibility to

ensure that you wipe clean the entire surface you come into contact, paying particular

attention to any keys you may touch.

Bin – Wipe the entire surface of the bin lid, to include sides and edges. Always operate

the bin by using the foot pedal where available.

Note: it is the responsibility of the individual to ensure that at regular points throughout the day they complete the cleaning of their own working space and carry out additional hand hygiene practices. End of Shift: Adhere to the clear desk Policy – This will enable domestic service to complete a full clean of desktops and surfaces. Perform Hand Hygiene Patient Transport Services (PTS) Vehicle Decontamination

Following transportation of a suspected or positive COVID-19 patient the vehicle will require an

enhanced between patient clean, ensuring thorough decontamination of all exposed surfaces,

equipment and contact areas before it is returned to normal operational duties, with or a

chlorine based product.

Appropriate Personal Protective Equipment (PPE) must be worn as directed by the latest Public

Health England Guidance, whilst decontaminating the vehicle.

All PPE waste should be disposed of as category B clinical waste.

Any exposed equipment including stretcher on the vehicle will require decontamination.

All contact surfaces, working from top to bottom in a systematic process, will require

decontamination.

Pay special attention to high touch points.

The vehicle floor should be decontaminated with chlorine solution; this should be at a

minimum of the end of shift, more frequently where facilities exist.

Methodology

Equipment required:

Chlorine Tablet




Yellow hand bucket

Yellow disposable cloths

Yellow flat mop stale


Clinical waste bags

Clinical waste ties


Wash hands

Put on PPE

Ensure the area is well ventilated

Check COSHH Data on product label

Check chlorine product is in date

Using you diluter, fill with cold water up to the two litre line

Place two chlorine tablets into the cold water

Allow tablets to dissolve, this will take approximately 9 – 12 minutes

Gently mix diluted product, but do not shake

The product is now ready for use. Standard PPE required for environmental decontamination of PTS Vehicle:

Disposable gloves


Disposable plastic apron

Eye protection, goggles or visor

Commencing the clean Note: prior to commencing the clean, pre–soak all your required cloths and mops in chlorine solution. Transfer your entire cleaning equipment to the Ambulance.

Starting with the ceiling, place your pre-soaked disposable flat mop adjacent to the edge

of the ceiling, and go around the edges of the vehicle, until you come back to your

starting point.

Keeping your mop flat against the ceiling, work your mop across the entire surface using

a figure of eight movement, overlapping with each sweep. Continue until all ceiling has

been cleaned.

Place the used disposable flat mop into the clinical waste bag for disposal.

Walls of vehicle, using a fresh pre-soaked disposable flat mop, go up edge of wall,

across top of wall and down the adjacent edge. Using a single sweeping, overlapping

motion, working from top to bottom of wall, ensuring the whole surface has been cleaned.




Windows can be cleaned as part of the wall process, remembering to buff dry on

completion.

Repeat this process on all wall surfaces.

Place the used disposable flat mop into the clinical waste bag for disposal.

Using a fresh pre-soaked disposable cloth commence to clean all vertical and horizontal

fixtures and fittings, using a fresh pre-soaked disposable cloth for each element. These

elements are to include:

Seats

Seat belts

Seats:

Starting at the bottom of the back of seat, using one continuous, long, overlapping,

upwards and downwards stroke wipe clean the whole area.

Following same method wipe clean sides and front of chair.

Place the used disposable cloth into the clinical waste bag for disposal.

Seat belts:

Extend belt to its full length, wrap disposable pre-soaked cloth around the top, and slowly

allow the belt return to original position, whilst ensuring both sides of the belt are cleaned

with chlorine solution.

Place the used disposable cloth into the clinical waste bag for disposal.

Floor Cleaning:

Using a dry disposable flat mop, commencing at the edge of the furthest point away from

the doors, using a sweeping, overlapping figure of eight motion, walking backwards,

sweep entire floor surface.

At end of task, place all debris into clinical waste bin, including mop.

Using yellow disposable flat mop, pre-soaked with chlorine solution, commence at the

edge of the furthest point in the room away from the door, using a sweeping, overlapping

figure of eight motion, walking backwards towards the door, damp mop entire surface of

the floor.

Upon mop drying out, dispose and replace with a fresh disposable flat mop, pre-soaked

in chlorine solution.

Place all used disposable mops in clinical waste bag for disposal.

When completed ventilate the vehicle and allow to dry prior to returning to operational duties

End of task




Check to ensure all disposable items, including those used for cleaning have been

removed.

Check mops stales have been washed thoroughly with chlorine solution prior to being

removed from the vehicle.

Discard all waste as category B clinical waste.

Community Staff Daily Vehicles Decontamination Guidance Scope During the COVID-19 pandemic, community healthcare staff should ensure they disinfect their vehicles safely and effectively as coronavirus can survive on surfaces. By adhering to this guidance, reduces the risk of cross transmission. The guidance below advises on daily decontamination of staff vehicles at the end of working day or when additional decontamination is required. Additional decontamination maybe required following a visit to a patient with confirmed or suspected coronavirus or if visibly soiled. Community staff must adhere to effective hand hygiene and effective use of Personal Protective Equipment (PPE). Disinfectant wipes, PPE should be stored in car boot. At the start of each day, apply plastic seat cover and ensure adequate stocks of disinfectant wipes and PPE are available. Personal Protective Equipment

Disposable gloves

Disposable aprons

Type 2 Fluid Resistant Surgical Masks (FRSM)

Eye protection –visor/goggles

Alcohol hand sanitiser gel

Equipment required:

Disinfectant/detergent wipes

Small waste bag

Plastic seat covers

Standard Operating Procedure:

Open car boot and apply alcohol hand sanitiser gel

Apply PPE - disposable gloves, apron, Type 2 FRSM, eye protection

Remove plastic seat covering from seat and place in waste bag

Using a disinfectant wipe for each element, wipe all high touch points in the car

thoroughly. These should include: car keys, ignition/power button (if applicable), steering

wheel, indicator stalk, gear stick, hand brake, door handle inside and outside, window

operating mechanism, seatbelt clip and holder then boot handle

Place all used disinfectant wipes in waste bag

Remove PPE and place and secure in waste bag

Dispose of waste at end of working day




6. Roles & responsibilities Domestic Services The Domestic Service Manager is responsible for ensuring that domestic staff required to undertake environmental decontamination effectively for suspected and confirmed COVID-19 cases have received competency based training in:

correct methods of wearing, removing and disposing of appropriate Personal Protective

Equipment (PPE) including AGP level; surgical gown and Filtering Face Piece (class 3)

FFP3 Respirator as per latest guidance

safe and effective environmental decontamination procedures

Prior to commencing any cleaning duties domestic staff, must confirm with clinical staff, areas of isolation, including side rooms, cohorted patient bays and clinical rooms are located. It is essential to clarify the level of PPE required in critical care areas or when potential AGP’s are present. Hand hygiene must be performed and PPE changed each time prior to moving between patient side rooms, clinical rooms or cohorted patient bays. Maintaining social distancing and observing the maximum room occupancy levels should be upheld at all times. Domestic staff experiencing difficulties implementing this SOP or have any concerns should immediately report to their line manager. Clinical Staff The prevention and management of infection is the responsibility of all staff is an integral element of patient safety and reducing the risk of nosocomial infection. Whilst working within the clinical environment, staff should ensure that areas are kept clean and clutter free at all times. Effective decontamination of equipment and the environment should be performed before and after use. Additional to clinical cleaning schedules determined locally, frequent high touch point cleaning helps reduce the risk of nosocomial infection. Non-clinical Staff Particularly during the pandemic, staff have a responsibility to ensure they work together to achieve a safe working environment, supported by the Working Safely Guidance: (https://www.pat.nhs.uk/Coronavirus/Clinical-operational-guidance/General/WORKING%20SAFELY%20DURING%20COVID-19%208.6.20.pdf) Ensuring the environment is kept clean and clutter free, frequent high touch point cleaning should be performed to help reduce risk on nosocomial infection.

7. Monitoring document effectiveness This document does not requiring a monitoring process.

https://www.pat.nhs.uk/Coronavirus/Clinical-operational-guidance/General/WORKING%20SAFELY%20DURING%20COVID-19%208.6.20.pdfhttps://www.pat.nhs.uk/Coronavirus/Clinical-operational-guidance/General/WORKING%20SAFELY%20DURING%20COVID-19%208.6.20.pdf




8. Abbreviations and definitions

List all abbreviations or acronyms in alphabetical order (even if they are explained within the document as well), for example: NCA Northern Care Alliance FRSM Fluid Repellent Surgical Mask PPE Personal Protective Equipment

9. References

NA




10. Document Control Information

Part 1 Must be fully completed by the Author prior to submission for approval

Name of lead author: Louise Simpson Paula Challoner

Job Title: Group Senior Nurse, Estates & Facilities Group Cleaning Lead Training and Compliance

Contact number: 07714139984 07970956088

Email address: [email protected] [email protected]

Consultation: List persons/groups included in consultation. N.B Include Pharmacy/PADAT/D&T/MMG for

documents containing drugs.

Indicate whether feedback used (FU), not used (FNU) or not-received (NR)

Name of person or group Role / Department / Service / Committee

/ Corporate Service

Date Response:

FU / FNU / NR

Clinical Advisory Group Committee 04/12/2020 FU

EqIA sign off: See Appendix 11

Name: (Insert named lead from EDI Team) Date:

J McMahon 16/12/2020

Communication plan:

Disseminated via internal Communications, published on the Intranet and also on the Document Management

System at both PAHNT and SRFT.

Part 2 Must be fully completed by the Author following committee approval.

Failure to complete fully will potentially delay publication of the document.

Submit to Document Control/Policy Support for publication.

Approval date: Method of document approval:

11/12/2020 Formal Committee decision

Yes / No

Chairperson’s approval

Yes / No

Name of Approving

Committee

Clinical Advisory Group

Chairperson Name/Role Simon Featherstone, Director of Nursing SCO

Amendments approval: Name of approver, version number and date. Do not amend above details.

Part 3 Must be fully completed by the Author prior to publication

Keywords & phrases: Environment, decontamination, cleaning, infection prevention, Covid-19, personal

protective equipment, PPE, disinfectant, cleansing wipes

Document review

arrangements

Review will occur by the author, or a nominated person, within five years or earlier

should a change in legislation, best practice or other change in circumstance

dictate.

mailto:[email protected]:[email protected]




11. Equality Impact Assessment (EqIA) tool

1. Possible Negative Impacts

Protected Characteristic Possible Impact Action/Mitigation

Age Potential bias from supervisors/managers regarding individuals capabilities

Individual risk assessment/agreement

Disability Staff with Respiratory conditions/Diabetes

Individual risk assessment, PPE as per section 5

Visual Impairments Policy available in different formats as stated in section 7 below. Also available via Computer with Browse Aloud.

Ethnicity No

Gender No

Marriage/Civil Partnership No

Pregnancy/Maternity Yes Individual risk assessment/agreement

Religion & Belief No

Sexual Orientation No

Trans No

Other Under Served Communities (Including Carers, Low Income, Veterans)

No

2. Possible Opportunity for Positive Impacts Protected Characteristic Possible Impact Action/Mitigation

Age N/A

Disability N/A

Ethnicity N/A

Gender N/A

Marriage/Civil Partnership N/A

Pregnancy/Maternity N/A

Religion & Belief N/A

Sexual Orientation N/A

Trans N/A


N/A




5. EqIA Update Log (Detail any changes made to EqIA as policy has developed and any additional impacts included)

Date of Update Author of Update Change Made

3. Combined Action Plan

Action (List all actions & mitigation below)

Due Date Lead

(Name & Job Role)

From Negative or Positive Impact?

Individual risk assessment/agreement December 2020

Louise Simpson Group Senior Nurse - Estates & Facilities

Positive

Individual risk assessment, PPE as per section 5

December 2020

Louise Simpson

Positive

Policy available in different formats as stated in section 7 below. Also available via Computer with Browse Aloud.

December 2020

Louise Simpson

Positive

4. Information Consulted and Evidence Base (Including any consultation)

Protected Characteristic Name of Source

Summary of Areas Covered

Web link/contact info

Age

Disability

Ethnicity

Gender

Marriage/Civil Partnership

Pregnancy/Maternity

Religion & Belief

Sexual Orientation

Trans


6. Have all of the negative impacts you have considered been fully mitigated or resolved? (If the answer is no please explain how these don’t constitute a breach of the Equality Act 2010 or the Human Rights Act 1998) Impact has been mitigated as described above in section 1 7. Please explain how you have considered the duties under the accessible information standard if your document relates to patients?

The policy will be available to staff in different formats, including large print, enlarged on computer screen and/or on different colour paper.

8. Equality Impact Assessment completed and signed off? (Insert named lead from EDI Team below). Please also add this information within Section 11.

Name: Date: 16/12/2020