How to Clean and Disinfect Environmental Surfaces in Healthcare Settings

Environmental surfaces are the surfaces of equipment, chairs, furniture, walls, and flooring. It is essential that they are cleaned and disinfected between each patient or on a routine basis. Environmental surfaces, also categorized as clinical contact or housekeeping surfaces, are all considered non-critical surfaces. Environmental surfaces do not contact patients directly; however, they can become contaminated during patient care. Environmental surfaces have not been associated directly with disease transmission but can serve as reservoirs of microbial contamination.

Clinical Contact Surfaces

The first category of an environmental surface, which is called a clinical contact surface, are those surfaces that are directly touched by contaminated gloves, instruments, or devices. These surfaces can become contaminated with patient blood or body fluids from spray or splatter that is generated during procedures. These surfaces can then contaminate other instruments, devices, hands, or gloves. A few examples of clinical contact surfaces are door handles, light switches, drawer handles, countertops, pens, computer keyboards, and computer mouse.

Housekeeping Surfaces

Housekeeping surfaces are the second category of environmental surfaces. These surfaces are not directly touched when providing care to a patient and have a minimum risk for disease transmission. Examples of housekeeping surfaces are floors, walls, and sinks. Most of these surfaces can be cleaned using detergent and water or you may use an EPA registered hospital disinfectant/detergent. They should be cleaned on a regular basis. Each facility should implement a cleaning schedule.

How to Manage Surfaces

Managing clinical contact surfaces is accomplished either with surface barriers or cleaning and disinfecting. Some facilities use a combination of the two. There are many options available for barriers and disinfectants. Each facility should determine which products work best and what protocols work best for the practice.

Surface barriers are recommended on those difficult to clean surfaces. Barriers boost safety of the employee and efficiency; it takes less time to prepare for the next patient and reduces the exposure to chemicals to the employee. Surface barriers are available in different sizes for almost any surface. They can be plastic wraps, bags, tubing, plastic-backed paper, or other materials. Once the barrier is removed from the surface, the surface should be examined to see if it became contaminated. If the surface doesn’t become contaminated, a new barrier can be placed. If the surface is contaminated, the surface needs to be cleaned and disinfected before a new barrier is placed. All surfaces covered with a barrier should be cleaned at the beginning of the day and at the end of the day.

Cleaning and Disinfecting Methods

There are two ways to clean and disinfect surfaces: the spray-wipe-spray method or wipe-discard-wipe. An EPA registered hospital-level disinfectant with tuberculocidal claims should be used. Each method begins with donning the appropriate personal protective equipment (PPE), such as utility gloves, masks, eyewear, and protective jackets. Always follow manufacturer’s instructions for use on the disinfectant’s recommended PPE.

When spray-wipe-spray is used, put on appropriate PPE and determine the surfaces that need to be cleaned and disinfected. When the disinfectant used must be prepared, ensure that it is prepared correctly according to the disinfectant’s label instructions. The label instructions state information on dilution, shelf life, use life, and expiration date. When the disinfectant comes prepared, always follow label instructions for use.

Spray-wipe-spray Method

The following is a step-by-step guide on how to utilize the spray-wipe-spray method:

1. Spray the surface with a cleaning agent: some EPA registered hospital disinfectants can be used to preclean the surface. Follow instructions for use. The instructions will state if it can be used as a cleaning agent.
2. Wipe the surfaces with paper towels: this is to clean the surfaces of all blood, debris, and body fluids.
3. Spray the surfaces with an EPA hospital disinfectant with tuberculocidal claims.
4. Allow the surface to remain wet for the contact time of the disinfectant (found on the instructions), meeting the tuberculocidal claim if the surface had blood present.
5. Wipe the surfaces dry after the contact time has been satisfied.

Wipe-discard-wipe Method

For the wipe-discard-wipe method, follow these steps:

1. Follow label instructions: ensure the wipe is also a cleaning agent.
2. Wipe the surfaces to be cleaned, follow label instructions on the number of wipes used. Some wipes are effective on a limited surface area. Use the appropriate number of wipes to preclean the surfaces of all blood, debris, and body fluids.
3. Discard the wipes used.
4. Saturate the surfaces with another wipe(s), follow instructions on the number of wipes to be used.
5. Allow the surfaces to remain wet for the contact time of the disinfectant, meeting the tuberculocidal claim if the surface had blood present.
6. Wipe the surface dry after satisfying the contact time.

Consult the equipment manufacturer prior to cleaning and disinfecting to understand which chemicals (disinfectants) are compatible with the equipment. This will preserve the life of the equipment. Remember to always follow the label instructions on disinfectants and wear appropriate PPE. Ensuring these are followed will reduce the risk of disease transmission in the healthcare facility.