Transcript
“Step by Step” Health Care Sanitation Program
Sustainable Solutions for Health, Productivity and the Environment.
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RMC Health Care Sanitation Program Contents Corridor Maintenance Prodedures.................................................................4-8. Initial Clean Up..................................................................................................4
Daily Sanitation.....................................................................................7
Weekly or Periodic Corridor Care.........................................................8
Floor Care Procedures.................................................................................9-11
Stripping and Coating...........................................................................9
Disinfection of Operating and Delivery Rooms Floors........................10
Post Operation Cleaning and Disinfecting..........................................10
Daily Cleaning and Disinfecting for Operating and Delivery Rooms... 11
Disinfection ...............................................................................................12-15
Recommended Disinfection Schedule................................................12
Cleaning and Disinfecting Environmental Surfaces............................13
Patient Care Areas......................................................................13.
Spills of Blood and Body Substances.................................................14
Carpeting and Cloth Furnishings.................................................15
Restroom Maintenance System Cleaning..................................................16-17 Hand Hygiene Recommendation.....................................................................18
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RECOMMENDED PROCEDURES FOR CORRIDOR MAINTENANCE
The following recommended procedures for corridor maintenance, if properly followed, would enable you to meet safe bacteriological cleanliness standards, and to do this work with a minimum expenditure of man-hours. Periodic bacteriologic monitoring of corridor floors should reveal counts not exceeding 10 organisms per square centimeter. This is considered a safe level for corridors.
Initial Cleanup of Corridors Initial Cleanup of Corridors Equipment and tools needed: A battery-powered automatic floor maintenance machine equipped with a wet and dry vacuum pickup system with filters approved for hospital use. Nylon tape scrubbing pads for automatic machine. An electric wet or dry pickup vacuum with cable which plugs into a wall outlet, or a cordless, battery-powered vacuum with hospital approved filters. Two 32 to 44-quart buckets and wringer on caster mop truck. Disinfectants: Environmentally Preferable “Green” Neutral Disinfectants options: o SNAP EC Neutral Disinfectant – Diluted ½ oz per gallon o EC Neutral Disinfectant - Diluted 2 oz per gallon
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Initial Clean Up Procedures
Worker #1: 1. Place “Caution” signs around area to be cleaned. 2. Begin dry vacuuming corridor using electric or battery-powered vacuum equipped with freshly laundered filter. Worker #2: 1. Prepares disinfectant solutions and readies automatic machine. 2. Fill both buckets on mop truck with EC Neutral Disinfectant solution for heavy duty cleaning. 3. Fill dispensing tank on automatic machine with EC Neutral Disinfectant to be used for the final rinse. 4. Equip machine with clean scrubbing pads. Attach squeegee floor tool, removes filter bag from vacuum (if it was in place), and disconnect machine from charger.
RECOMMENDED PROCEDURES FOR CORRIDOR MAINTENANCE Initial Clean Up Procedures
Worker #1: 1. Returns vacuum to storage room. 2. Take clean mop and mop truck carrying two buckets of EC Neutral Disinfectant solution to corridor and begins by cleaning baseboards. Make sure to keep mop wet not just damp to accomplish hygienic mopping. There must always be an excess of solution in the pail, and the mop must carry adequate amounts of solution to the baseboards and floor. 3. Remove the saturated, dripping mop from the pail, press the heel of the mop against the baseboard, and with a scrubbing action, cleans 8 to 10-foot sections of the baseboard with each mop-full of solution. Clean the baseboards in this manner on both sides of the corridor for a 30 to 40-foot length. 4. Lay generous amounts of solution over the entire corridor - walk backwards and work the mop from one side of the aisle to the other with overlapping passes. The floor must be thoroughly wet over its entire surface. Worker #2: 1. Begin scrubbing with the automatic machine by starting next to one wall of the corridor and scrubbing down entire length where solution has been laid. 2. On the first scrubbing pass, the machine’s squeegee should be in the “up” position and the vacuum turned off. Scrub the entire area of the corridor, which has had solution applied to it by making overlapping passes until the entire width has been scrubbed. 3. On the second pass, scrub the same area in the same manner, this time with the squeegee “down” and the vacuum turned on. The solution will be recovered into the vacuum tank on this pass. 4. Go over the same area scrubbing a third time, and on this pass, releases a steady flow of EC Neutral Disinfectant solution from the machine. The squeegee should be down and the vacuum turned on for immediate pickup of this final disinfectant rinse solution. 5
RECOMMENDED PROCEDURES FOR CORRIDOR MAINTENANCE Initial Clean Up Procedures
Worker #1: 1. While Worker #2 is making the “pickup” pass with the machine, Worker #1 can help speed the work by pulling solution out of corners and away from baseboards with the hand squeegee into position where it can be easily picked-up with the machine. 2. Following the machine on the third “rinse” pass, Worker #1, using another clean mop and bucket of fresh EC Neutral Disinfectant solution, can pick up any streaks or small puddles of solution which might be left by the machine at the “turn-arounds.” The mop should be dipped into the solution and wrung out in the mop press frequently during this final touchup process. 3. Worker #1 should also wipe down the baseboards. He does this by pressing the heel of the damp mop against the baseboard and walks the length of the section just cleaned. Worker #2: 1. Return the machine to storage room, empties and cleans tanks, and removes and cleans pads. 2. Prepare equipment necessary to apply the finish. Finish should be applied in the following manner: 3. Fill clean (disinfected) bucket with a gallon of EC Floor Finish 4. Immerse a freshly laundered, finish mop in the liquid. Wring out in mop press. 5. Keeping mop 4” away from baseboard, worker drags mop up on one side of the corridor and down the other - making two parallel paths - one on each side of the corridor. 6. Walk backwards down the corridor, working the mop back and forth between the two parallel paths, filling in the remainder of the floor area. Immerse mop in the finish and wring out mop as often as necessary to maintain a thin, even coat over the entire floor. (Apply one thin coat only. Do not return any unused finish to storage container.) Worker #1: After having properly cleaned and stored mop truck, buckets, and other tools he has used, Worker #1 prepares the automatic machine for the final polishing and dry vacuuming process. As stated earlier, this can be done immediately following the wet cleaning process just describe with safety if these precautions are observed:
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a. Use clean disinfected polishing brushes or pads on the automatic machine. b. Use a clean, disinfected filter bag in the vacuum, and a disinfected bristle floor tool. c. Perform the combination polishing and dry vacuuming process immediately after the finish on the floor has dried.
The workers should, of course, return their tools to the storage area, clean and store them properly, empty and clean vacuum tank, and wipe off the machine with a rag moistened with ready-to–use Quat Plus TB disinfectant solution. This concludes the initial cleanup process. As stated, this process should not be necessary again for six months or more provided the floor receives proper daily care thereafter.
Daily Sanitation of Corridors
Following the initial cleanup, the daily sanitation program can be put into effect. The following procedures are recommended for doing this job with maximum efficiency and with results that will satisfy bacteriological safety requirements.
RECOMMENDED PROCEDURES FOR CORRIDOR MAINTENANCE Initial Clean Up Procedures Daily Sanitation of Corridors
1. Begin by dry vacuuming corridor using electric or battery-powered vacuum, equipped with a freshly laundered filter bag. 2. Fill dispensing tank on automatic machine with SNAP EC Neutral Disinfectant at ½ oz to a gallon of water dilution. Equip machine with clean scrub brushes, attach squeegee floor tool, removes filter bag from vacuum, and disconnect machine from charger. 3. Start scrubbing against one wall, up and down the corridor with overlapping passes, until the entire corridor width has been scrubbed. On each pass, the machine lays the disinfectant solution, scrubs, vacuums up the solution, and damp-dries the floor. 4. Use a clean, disinfected mop and a bucket of fresh SNAP EC Neutral Disinfectant solution, pick up any streaks or small puddles of solution, which might be left by the machine at the “turnarounds.” Mop should be dipped into the solution and wrung out in the mop press frequently during this final touchup process. 5. Prepares machine for dry buffing and dry vacuuming by emptying and cleaning tanks, replacing squeegee floor tool with disinfected bristle floor tool, replacing scrub brushes with disinfected polish pads or brushes, and putting freshly laundered filter bag in place in the vacuum. 6. Return to corridor and following the same overlapping pattern previously described for scrubbing, buffs and vacuums. The machine will perform these two jobs at one time on each pass over the floor. To be hygienic, this buffing and dry vacuuming must be done immediately after the floor has been sanitized with the wet scrubbing process - just as soon as the floor has thoroughly dried. Dry buffing should not be permitted at any other time. Approximately 12 hours after corridor floors have been wet cleaned each day, they should be Dust mopped using disposable, disinfectanttreated dusting cloths. This will remove any accumulated dust that may have settled to the floor. 7
RECOMMENDED PROCEDURES FOR CORRIDOR MAINTENANCE Weekly or Periodic Corridor Care
Weekly or Periodic Corridor Care •
Once each week, corridor floors should be cleaned with the automatic machine using EC Neutral Disinfectant for deep cleaning and disinfecting.
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Once each week, or as often as necessary, immediately following the wet cleaning process with the detergent disinfectant, floor finish EC Floor Finish or Ultra Marathon should be applied to heavy traffic areas.
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For touchup of relatively small areas, such as in doorways, EC Enhancer or Flashback Restorer is helpful.
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For larger areas, the mop-on method, applying one thin coat, is recommended. After the finish has dried, the corridor can be machine-buffed and dry vacuumed with the automatic. •
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It is important that this refinishing and buffing be done immediately after the floor has been disinfected by the wet cleaning process. Be certain that the tools used to apply the finish and to buff the floor have been properly disinfected before use.
Stripping and Coating Procedures
Stripping is done when there is soil penetration that cannot be removed by scrubbing, there is a build up of finish due to improper application techniques or there is soil penetration into the floor finish itself. By stripping, we mean the complete removal of all of the existing finish Assemble the following: Wet floor signs Ultra Marathon or EC Floor Finish Thermo Strip or EC Floor Stripper Swing type floor machine Finish Mops* Rinse mops Mop bucket/wringer for stripping solution Mop bucket/wringer for rinse water
Automatic scrubber with red pads Automatic Scrubber filled with clear water & equipped with red pads Mop pail with plastic liner/wringer Scrappers, Doodlebugs Black stripping pads Stripper Mops Dust mop
Procedures: 1. Put out Wet Floor signs 2. Dust mop floor to be stripped 3. Mix Thermo Strip or EC Floor Stripper at 32 oz per gal water in mop pail 4. Put clear water in automatic scrubber 5. Apply to area of floor to be scrubbed, allow to work for 5-7 minutes 6. Use the Doodlebug to scrub areas where the automatic scrubber won’t reach 7. Fit black pad to swing floor machine and thoroughly scrub a section of floor 8. Do not allow scrubbed area to dry 9. Scrub and pick up with automatic scrubber & spot mop with clear water as needed 10. Repeat steps 7 – 9 until entire area is stripped. 11. Using automatic scrubber, scrub the entire area again with clear water 12. Allow to dry thoroughly 13. Apply first coat of Ultra Marathon or EC Floor Finish within wear area. Stay 12” away from walls and other non-traffic areas. 14. Allow to dry a minimum of 30 – 40 minutes 15. Apply second coat of Ultra Marathon or EC Floor Finish within wear area. Stay 12” away from walls and other non-traffic areas. 16. Apply third coat of Ultra Marathon or EC Floor Finish to entire floor & allow to dry. 17. Do not apply more than 3 coats in one night. The following night, perform procedures shown under DAILY MAINTENANCE, followed by two three more coats of Ultra Marathon or EC Floor Finish , per steps 13 – 16 above. Allow 24 hours or more cure time before burnishing.
RECOMMENDED FLOOR CARE PROCEDURES Stripping and Coating Procedures
Safety
Every employee should be trained on the proper use of any chemical product and maintenance equipment, as well as the procedure to follow in the event of a spill, or skin, eye or respiratory irritation. Report any incident to your supervisor immediately. Personal protective equipment should always be used in accordance with the requirements shown on each product’s MSDS. Every secondary container, such as a spray bottle, should be labeled with labels supplied by the product manufacturer.
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RECOMMENDED FLOOR CARE PROCEDURES Disinfection of Operating & Delivery Room Floors
Post Operation Cleaning & Disinfecting Procedures for Operating and Delivery Rooms
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Disinfection of Operating and Delivery Room Floors
Operating and delivery room floors call for special sanitation techniques because they must be the cleanest floors in the hospital from a bacteriological standpoint - not exceeding a count of 5 organisms per square centimeter. The following equipment is recommended for operating and delivery room floor disinfections: •
A single-disc floor-scrubbing machine with a brush or pad diameter of 15” to 17”. This machine may be equipped with a solutiondispensing tank mounted on the handle.
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A wet/dry pickup vacuum cleaner with a dual filtering system proven safe for hospital use.
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One 12-quart sprinkling can (if floor machine not equipped with dispensing tank).
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Supply of freshly laundered, disinfected 16 or 24-ounce cotton or rayon wet mop heads, and suitable mop handle.
Post Operation Cleaning and Disinfecting Procedures for Operating and Delivery Rooms 1.
Pick up gross debris and placed in a bag for disposal.
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Fill a sprinkling can with a fresh solution of SNAP EC Neutral Disinfectant at ½ oz per gallon.
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Sprinkle one quart of the detergent disinfectant in the central soiled area of the floor.
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Use a freshly laundered mop head to scrub this area to disSolv dried blood, pus, or soil.
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Pour the remainder of the detergent disinfectant on the scrubbed area and spread to cover the periphery.
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After the entire floor has been flooded, the film of water is removed with the wet pickup vacuum cleaner.
Daily Cleaning and Disinfecting Procedures for Operating and Delivery Rooms 1.
Remove all furniture from the room to make the entire floor surface available.
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Gross debris should be picked up and placed in a bag for disposal.
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Shelving, moldings, and lamps are wiped with a cloth wrung dry from a solution of SNAP EC Neutral Disinfectant.
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A fresh solution of SNAP EC Neutral disinfectant is prepared in the floor machine’s dispensing tank.
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Beginning in the central soiled area of the room, the entire floor should be scrubbed with the floor machine. Enough solution should be released to thoroughly flood the entire surface.
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After the entire floor has been flooded and machine scrubbed, the film of solution should be removed with the wet pickup vacuum cleaner.
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The operating room furniture, including the casters, should be wiped with a cloth dampened in a disinfectant prior to returning it to the clean room.
RECOMMENDED FLOOR CARE PROCEDURES Daily Cleaning & Disinfection Procedures for Operating & Delivery Room Floors
NOTE: A wet pickup vacuum cleaner is essential to remove the slurry of dirt and bacteria loosened from the floor. In this way, a grossly clean and bacteriologically safe floor is attained. The bacterial count on the unused surface of the floor 12 hours after this cleaning process should be less than five organisms per square centimeter. There should be no dust. Air-borne counts should not exceed one bacterium per cubic foot. Mops used in the operating room must be laundered daily. Mops must not be stored submerged in used cleaning solution. The textile and dirt deplete the disinfectant, and bacterial multiplication occurs. The concentration of disinfectant or quantity used on each type of floor must be determined by bacteriologic experiment. Most disinfectants have inherent properties that interfere with their action. Thus hard water, the mop, dirt and debris on the floor, and the flooring itself, deplete the solution of its germicidal or detergent action. Enough disinfectant must be used to satisfy these affinities.
Recommended Schedule for Floor Disinfection
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RECOMMENDED PROCEDURES FOR DISINFECTION
Daily Disinfections Corridors, lobbies, dressing rooms, emergency wards, isolation rooms, nurseries, pediatric wards, and utility rooms should be disinfected by the wet pickup process daily.
Recommended Schedule for Floor Disinfection
When the size of the floor permits, an automatic scrubbing and vacuuming machine should be used. In smaller, congested areas, the disinfectant solution should be flooded on the floor with a mop, and then recovered with a wet pickup vacuum cleaner. Disinfection After Each Operation Operating and delivery room floors should be disinfected after each operation and delivery as previously described. Once each day, they should receive a more thorough cleaning with a scrubbing machine, and all equipment in the room wiped down with a disinfectant treated cloth. Weekly Disinfection Medical and surgical service areas should be disinfected weekly. Here again, where the size of the floor permits, an automatic scrubbing and vacuuming machine should be used. Terminal Disinfection Autopsy room, maternity wards and single patient rooms. Floors in these rooms must also be flooded with disinfectant solution, and not merely just damp-mopped. Solution should be recovered with a wet pickup vacuum. Terminal disinfections, in addition to having the floor sanitized, should include fogging with a disinfectant spray, and all furniture and equipment in the room should be wiped down with disinfectant-treated cloths.
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Cleaning and Disinfecting Environmental Surfaces I. Cleaning and Disinfecting Environmental Surfaces in Patient Care Areas Α. Clean non-critical medical equipment surfaces with a SNAP EC Neutral disinfectant at ½ oz per gallon. 1. Apply with dampened cloth, sponge or spray on hard non-porous surfaces and allow 10 minutes contact time. B. Use barrier protective coverings as appropriate for non-critical surfaces that are: 1. Touched frequently with gloved hands during the delivery of patient care 2. Likely to become contaminated with blood or body substances 3. Difficult to clean (e.g., computer keyboards).
RECOMMENDED PROCEDURES FOR DISINFECTION Cleaning and Disinfecting Environmental Surfaces Patient Care Areas
C. Clean housekeeping surfaces (e.g., floors, walls, tabletops) with SNAP EC Neutral Disinfectant a regular basis and clean up spills promptly. D. Use SNAP EC Neutral Disinfectant for general housekeeping purposes in patient care areas where 1. Uncertainty exists as to the nature of the soil on the surfaces (e.g., blood or body fluid contamination versus routine dust or dirt) 2. Uncertainty exists regarding the presence of multi-drugresistant organisms on such surfaces. E
Use PH-7 or SNAP EC Low Foam All Purpose Cleaner for cleaning surfaces in non-patient care areas (e.g., administrative offices).
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Clean and disinfect high-touch surfaces (e.g., doorknobs, bed rails, light switches and surfaces in and around toilets in patient’s rooms) with SNAP EC Neutral Disinfectant.
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Clean walls, blinds and window curtains in-patient care areas with SNAP EC Neutral Disinfectant when they are visibly dusty or soiled.
NOTE: 1. Avoid large surface cleaning methods that produce mists or aerosols, or disperse dust in patient care areas (37, 48, 51, 73). Category IB. 2. Do not use alcohol to disinfect large environmental surfaces.
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RECOMMENDED PROCEDURES FOR DISINFECTION Cleaning and Disinfecting Environmental Surfaces Spills of Blood and Body Substances
II. Cleaning Spills of Blood and Body Substances A. Promptly clean and decontaminate spills of blood or other potentially infectious materials (293 - 300). Category IB, IC (OSHA: 29 CFR 1910.1030 § d.4.ii.A). B. Follow proper procedures for site decontamination of spills of blood or blood-containing body fluid (293 - 300). Category IC (OSHA: CFR 1910.1030 § d.4.ii.A). 1. Wear 2 pair protective gloves and other PPE like masks, splash goggles and face shields for eye protection. (293). Category IC (OSHA: 29 CFR 1910.1030 § d.3.i, ii). 2. If the spill contains large amounts of blood or body fluids, clean the visible matter with disposable absorbent material and discard the used cleaning materials in appropriate labeled containers (293, 298, 299, 301, 302). Category IC (OSHA: 29 CFR 1910.1030 § d.4.iii.B). 3. Swab the area with a cloth or paper towels moderately wetted with SNAP EC Neutral Disinfectant registered by
the EPA for use as hospital disinfectants and labeled tuberculocidalregistered disinfectants on the EPA Lists D and E, label claims for HIV hepatitis B virus [HBV]) in accordance with label instructions to decontaminate spills of blood and other body fluids (293, 301, 303). Category IC (OSHA 29 CFR 1910.1030 § d.4.ii. A memorandum 2/28/97; compliance document [CPL] 202.44D [11/99]) and allow
the surface to dry (293, 301). Category IC (OSHA: 29 CFR 1910.1030 § d.4.ii.A).
4. When washing exposed items, fill sink with water and SNAP EC Neutral Disinfectant, then place items in sink to soak.
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III. Carpeting and Cloth Furnishings A. Vacuum carpeting in public areas of health care facilities and in general patient care areas regularly with well-maintained equipment designed to minimize dust dispersion (280). Category II. B. Periodically perform a thorough, deep cleaning of carpeting such as the Extraction method with Sanex Carpet Extraction with Sanitizer at 2 oz per gallon. Avoid using a method that produces an aerosol effect and leaves residue (44). Category 1B. C. Follow appropriate procedures for managing spills on carpeting. 1. Spot-clean blood or body substance spills promptly (293, 301, 304, 307). Category IC (OSHA: 29 CFR 1910.1030 § d.4.ii.A, interpretation). Recommend Proxi Spray and Walk Away Hydrogen Peroxide Carpet and fabric spotter.
RECOMMENDED PROCEDURES FOR DISINFECTION Cleaning and Disinfecting Environmental Surfaces Carpeting & Cloth Furnishings
2. If a spill occurs on carpet tiles, replace any tiles contaminated by blood and body fluids or body substances (307). Category IC (OSHA 29 CFR 1910.1030 § d.4.ii interpretation). D. Thoroughly dry wet carpeting to prevent the growth of fungi; replace carpeting that remains wet for 72 hours (37, 160). Category IB. E. Periodic extraction cleaning with EC Carpet & Upholstery Cleaner for carpeting in public areas of a health care facility or in general patient care areas for fungicidal or bactericidal treatments. F. If upholstered furniture in a patient’s room requires cleaning to remove visible soil or body substance contamination, move that item to a maintenance area where it can be adequately cleaned with a process appropriate for the type of upholstery and nature of the soil. Category I.
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RESTROOM MAINTENANCE SYSTEM CLEANING
Attention to the following principles will help develop an efficient program 1. Follow an orderly pattern of movement 2. Clean objects that can be cleaned with the same products…. at the same time. 3. Plan your steps so cleaners and disinfectants will have time to work. 4. Clean from high to low, towards the doorway, and do dry before wet work. The order of jobs may need to be varied according to the characteristics of the restroom to be cleaned. However, following an orderly, systematic approach will reduce work and produce a more effective restroom maintenance program. 1. Check supply cart for proper equipment and supplies: SNAP EC Neutral Disinfectant Paper towels SNAP EC Glass Cleaner Toilet tissue SNAP EC Washroom Cleaner Trash liners EC Liqui Bac drain cleaner Mop bucket & wringer EC Hand Soap Bowl swab and caddy DfE VMR Graffiti Remover Sponge and rags Broom, dust pan or dust mop Proxi Cooncentrate for tile & grout
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Place a Restroom Closed sign at the door, if applicable.
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Dust vents, ledges, Dust mop or sweep the floor, then pick up all debris with dust pan.
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Clean and re-fill all dispensers (paper towel, toilet tissue, feminine hygiene, toilet seat covers, hand soap, etc.)
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Remove trash, and clean receptacles (paper towel, feminine disposal units) with SNAP EC Neutral disinfectant
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Clean all sinks with SNAP EC Neutral disinfectant
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Clean all mirrors using SNAP EC Glass Cleaner with soft, clean cloths. (Spray sparingly. Do not flood mirror with solution) Clean and disinfect the toilets and urinals. a. Remove urinal screens from the urinals and using the bowl swab, push water level down. b. Apply SNAP EC Washroom Cleaner to the exposed interior surfaces of the bowls and urinals. (specifically under the rim) c. Disinfect outer rim of bowls and urinals with SNAP EC Neutral Disinfectant
RESTROOM MAINTENANCE SYSTEM CLEANING
Damp wipe and remove graffiti from stall partitions and walls with DfE VMR Graffiti Remover.
10. Wet mop the floor with SNAP EC Neutral Disinfectant cleaner a. Start from the furthest corner of the washroom b. Make sure to clean the edges of the walls c. Work towards the door. d. Allow 10 minutes to air dry. 11. Inspect your work
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HAND HYGIENE RECOMMENDATION
Hand Hygiene Technique A. When decontaminating hands with an alcohol-based hand rub, apply product to palm of one hand, rub hands together covering all surfaces of hands and fingers, until hands are dry (IB) (288, 410). Follow manufacturer’s recommendations regarding the volume of product to use. B. When washing hands with soap and water, wet hands first with water, apply an amount of product recommended by the manufacturer to hands, and rub hands together vigorously for at least 15 seconds covering all surfaces of the hands and fingers. Rinse hands with water and dry thoroughly with a disposable towel. Use towel to turn off the faucet (IB) (90 - 92, 94, 411). Avoid using hot water, because the repeated exposure to hot water may increase the risk of dermatitis (IB) (254, 255). C. Liquid soaps are acceptable when washing hands with a nonantimicrobial soap and water. When bar soap is used, soap racks that facilitate drainage should be used (II) (412 - 415). D. Multiple-use cloth towels of the hanging or roll type are not recommended for use in health care settings (II) (137, 300).
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