Environmental cleaning

Transmission of VHF is primarily from direct contact with body fluids of an infected person. While the environment may become contaminated, spot cleaning of body fluid spills at the time of contamination minimises the risk of transmission.

Limit room entry to essential staff only. Routine and spot cleaning in the patient’s room should be undertaken by staff caring for the patient.

PPE

All staff involved in the cleaning and disinfection of the patient room or communal equipment must wear the appropriate Level 1 or Level 2 of PPE, according to the relevant area or room they are cleaning.

Disinfectants

While sodium hypochlorite has been proven to be effective at inactivating VHF viruses, there are several disinfectant products commonly used in health care settings that are registered with the Therapeutic Goods Administration (TGA) as being effective. This includes some two-in-one detergent/disinfectant wipes. Contact your cleaning supplier for information on products available at your site.

Any disinfectant product used must be used at the recommended strength for the appropriate amount of ‘kill’ time.

Chlorine-based disinfectants, such as sodium hypochlorite, are most commonly used for environmental disinfection for VHF. Where available, granule, powder or gel forms should be used for the initial management of spills to minimise the risk of aerosolisation.

Note: chlorine solutions lose potency quickly. As such, they should be made up in smaller quantities as required or, at a minimum, daily.

Routine and spot cleaning

Routine environmental cleaning should be undertaken using either:

• a two-step detergent clean (physical clean with detergent followed by a chemical disinfectant)
• combined two-in-one detergent/disinfectant clean (physical clean using a combined detergent/disinfectant wipe/solution).

For routine and spot cleaning:

• regularly clean and disinfect surfaces in the patient care area, even in the absence of visible contamination
• immediately clean and disinfect any visible contamination of surfaces or equipment (spot cleaning)
• clean and disinfect hard, nonporous surfaces daily, including frequently touched surfaces (for example, bed rails and over-bed tables), counters and floors
• use disposable cleaning cloths, mop cloths and wipes, and dispose of these in leak-proof bags. Use a rigid waste receptacle designed to support the bag to help minimise contamination of the bag’s exterior
• routine cleaning of the PPE doffing area should be performed at least once per day and after the removal of grossly contaminated PPE
• cleaning should be performed by a HCW wearing Level 1 or Level 2 PPE (see Personal protective equipment)
• when cleaning and disinfection are complete, the HCW should carefully take off their PPE and perform hand hygiene.

Medical equipment and devices

For use of medical equipment and devices, remember:

• Equipment in the room should be limited to only what is essential for patient care.
• Equipment must be dedicated for the sole use of the patient for the duration of their stay.
• Wherever possible, single-use equipment should be used and be disposed of as VHF waste when no longer required.

Reusable medical devices

For reusable medical devises, remember:

• Reusable medical devices should be cleaned and disinfected in the room.
• Any visible contamination should first be wiped off similarly as described in the spill section.
• The items should then be cleaned in a two-step process, with a neutral detergent first, then with a disinfectant specified in the manufacturers’ instructions.

Blood and body fluid spills

Larger blood and body fluid spills (greater than 10cm) should be managed in the following manner:

1. Contain the spill by applying paper towel, a spill mat or absorbent sheet. Dispose of waste into a clinical waste bag.
2. Apply sodium hypochlorite granules or gel to any remaining spill residue, then cover with paper towel.
3. Leave for 30 minutes.
4. Remove paper towel and wipe up granules. Dispose of into a clinical waste bag.
5. Clean the area of the spill with detergent, then disinfectant or a combined two-in-one detergent disinfectant wipe. Dispose of cloth/wipe into a clinical waste bag.
6. Disinfect the area of the spill with a cloth saturated with sodium hypochlorite 5,000 ppm. Leave for 30 minutes. Dispose of cloth into a clinical waste bag.
7. Dry area with paper towel. Dispose of items into a clinical waste bag.

Discharge cleaning

Discharge cleaning should be carried out as for routine cleaning with the following additions:

• A higher concentration of sodium hypochlorite (5,000 ppm) should be used.
• All textiles contaminated with body fluids, including curtains, should be disposed of as clinical waste.
• If a negative pressure ventilation room was used (for example, an AGP was conducted), maintain negative pressure during discharge cleaning and for 30 minutes afterwards, before another patient is admitted to the room. The pre-filter should also be changed and checked for damage by appropriate personnel.

Management of cleaning equipment

For management of cleaning equipment, remember:

• All single-use cleaning cloths and the mop head should be disposed of in double-bagged clinical waste.
• All cleaning equipment (mop handles and buckets if used) should be cleaned after each use and kept in the room until the patient is discharged, and cleaning has been completed.
• It is preferable not to pour liquid waste or leftover cleaning solutions into an ensuite toilet to prevent aerosolisation or risk of splash. Remaining cleaning solutions should be disposed of using absorbent granules or gel, which is then disposed of as double-bagged clinical waste.