Careful cleaning of patient rooms and medical equipment can contribute substantially to the overall control of MRSA, VRE and other infections. The CDC’s “Guidelines for Environmental Infection Control in Health-Care Facilities” says, the major focus of a control program for either VRE or MRSA should be the prevention of hand transfer of these organisms.

The Guidelines say, routine cleaning and disinfection of the housekeeping surfaces (e.g., floors and walls) and patient-care surfaces (e.g., bedrails) should be adequate for inactivation of these organisms. Both MRSA and VRE are susceptible to several EPA-registered low- and intermediate- level disinfectants (e.g., alcohols, sodium hypochlorite, quaternary ammonium compounds, phenolics, and iodophors) at recommended use dilutions for environmental surface disinfection.

The number and types of microorganisms present on environmental surfaces are influenced by the following factors: a) number of people in the environment, b) amount of activity, c) amount of moisture, d) presence of material capable of supporting microbial growth, e) rate at which organisms suspended in the air are removed, and f) type of surface and orientation [i.e., horizontal or vertical].

Strategies for cleaning and disinfecting surfaces in patient-care areas take into account a) potential for direct patient contact, b) degree and frequency of hand contact, and c) potential contamination of the surface with body substances or environmental sources of microorganisms (e.g., soil, dust and water).

Cleaning Housekeeping Surfaces

Housekeeping surfaces require regular cleaning and removal of soil and dust. Dry conditions favor the persistence of grampositive cocci in dust and on surfaces, whereas moist, soiled environments favor the growth and persistence of gram-nega-tive bacilli. Fungi are also present on dust and proliferate in moist, fibrous material. Most, if not all, housekeeping surfaces need to be cleaned only with soap and water or a detergent/disinfectant, depending on the nature of the surface and the type and degree of contamination.

Cleaning and disinfection schedules and methods vary according to the area of the health-care facility, type of surface to be cleaned, and the amount and type of soil present. Disinfectant/detergent formulations registered by EPA are used for environmental surface cleaning, but the actual physical removal of microorganisms and soil by wiping or scrubbing is probably as important, if not more so, than any antimicrobial effect of the cleaning agent used.

Therefore, cost, safety, product-surface compatibility, and acceptability by housekeepers can be the main criteria for selecting a registered agent. If using a proprietary detergent/disinfectant, the manufacturers’ instructions for appropriate use of the product should be followed. Consult the products’ material safety data sheets (MSDS) to determine appropriate precautions to prevent hazardous conditions during product application.

Personal protective equipment (PPE) used during cleaning and housekeeping procedures should be appropriate to the task. Housekeeping surfaces can be divided into two groups – those with minimal hand-contact (e.g., floors, and ceilings) and those with frequent hand-contact (“high touch surfaces”). The methods, thoroughness, and frequency of cleaning and the products used are determined by health-care facility policy.

However, high-touch housekeeping surfaces in patient-care areas (e.g., doorknobs, bedrails, light switches, wall areas around the toilet in the patient’s room, and the edges of privacy curtains) should be cleaned and/or disinfected more frequently than surfaces with minimal hand contact. Infection-control practitioners typically use a risk-assessment approach to identify high-touch surfaces and then coordinate an appropriate cleaning and disinfecting strategy and schedule with the housekeeping staff. Horizontal surfaces with infrequent hand contact (e.g., window sills and hardsurface flooring) in routine patient-care areas require cleaning on a regular basis, when soiling or spills occur, and when a patient is discharged from the facility.

Regular cleaning of surfaces and decontamination, as needed, is also advocated to protect potentially exposed workers. Cleaning of walls, blinds, and window curtains is recommended when they are visibly soiled.

Disinfectant fogging is not recommended for general infection control in routine patient- care areas. Further, paraformaldehyde, which was once used in this application, is no longer registered by EPA for this purpose. Use of paraformaldehyde in these circumstances requires either registration or an exemption issued by EPA under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA).

Infection control, industrial hygienists, and environmental services supervisors should assess the cleaning procedures, chemicals used, and the safety issues to determine if a temporary relocation of the patient is needed when cleaning in the room.