How should you clean a resident's room?: A Guide to Standard and Terminal Cleaning Protocols

Studies have demonstrated that patients admitted to a room previously occupied by someone infected with a pathogen are more likely to acquire that pathogen. To protect residents and staff, it is crucial to follow strict protocols regarding how should you clean a resident's room. This process involves distinguishing between routine daily cleaning and more intensive terminal cleaning procedures.

Quick Summary

This guide details the essential steps for cleaning a resident's room, outlining the proper procedures for daily sanitation and comprehensive terminal cleaning. It emphasizes the importance of cleaning high-touch surfaces and following a systematic approach to prevent cross-contamination and ensure infection control.

Key Points

• Standardized Protocols: Follow a consistent, systematic process for cleaning to ensure no surfaces are missed and to prevent cross-contamination.

• Clean First, Then Disinfect: Always remove visible dirt and soil with a cleaner before applying a disinfectant, allowing the disinfectant to work effectively.

• Prioritize High-Touch Surfaces: Focus on disinfecting surfaces like bed rails, call bells, and door handles, which are touched most frequently and pose the highest risk of germ transmission.

• Work Top-to-Bottom and Clean-to-Dirty: Clean higher surfaces before lower ones to catch falling debris, and save the dirtiest areas, like the bathroom, for last.

• Use Separate Cleaning Materials: Prevent cross-contamination by using different cleaning cloths and mop heads for each resident's room and changing them when they become soiled.

• Distinguish Between Cleaning Types: Understand the difference between routine daily cleaning and more intensive terminal cleaning for effective infection control.

• Wear Appropriate PPE: Always don gloves, and use additional protective equipment when necessary, to protect yourself and prevent pathogen spread.

Understanding the Types of Resident Room Cleaning

Effective cleaning of a resident's room depends on the situation. Care facilities generally employ two main types of cleaning: routine daily cleaning and terminal cleaning. A thorough understanding of each is necessary to prevent the spread of pathogens and maintain a safe environment.

Routine Daily Cleaning

This type of cleaning focuses on frequently touched surfaces and general tidiness. It is performed regularly, often daily, while the resident is still in the room. The goal is to reduce the bioburden and prevent germ buildup on surfaces that are most likely to transmit infection. The process is less intrusive and designed to be completed efficiently.

Terminal Cleaning

Terminal cleaning is a deep-cleaning process performed after a resident has been discharged, transferred, or has passed away. It is significantly more comprehensive than routine cleaning, targeting both high- and low-touch surfaces and reaching areas that are not cleaned daily. This procedure ensures the room is completely sanitized for the next occupant.

A Step-by-Step Guide for Effective Cleaning

Following a systematic order is critical to avoid re-contaminating surfaces. The generally accepted principle is to clean from high to low and from the cleanest areas to the dirtiest.

Preparation: The Foundation of Safe Cleaning

1. Gather Supplies: Prepare a cart with all necessary equipment, including gloves, appropriate disinfectants, sufficient clean cloths, trash bags, and mop heads.
2. Wear Personal Protective Equipment (PPE): Don gloves before entering the room. Assess if any additional PPE (e.g., gowns, masks) is required based on the resident's health status or isolation signs.
3. Announce Your Presence: Knock and announce yourself before entering to respect the resident's privacy.
4. Asses the Room: Note any spills or visible soil that may require special handling.

The Cleaning Process: Top-to-Bottom, Clean-to-Dirty

• Remove Waste and Linens: First, empty the trash. Carefully remove soiled linens, blankets, and towels, rolling them up to avoid shaking loose particles into the air. Do not hug or hold soiled items close to your body. Place them immediately into a designated laundry bag.
• High Dusting: Start with high surfaces like light fixtures, air vents, and window sills using a high-duster to collect debris. This prevents dust from settling on already-cleaned surfaces below.
• Clean and Disinfect Surfaces: Working from high to low, and clean to dirty, wipe down all surfaces. Remember to clean before disinfecting to ensure the disinfectant can work effectively.
  • Apply an EPA-approved disinfectant, following the product's dwell time recommendation. The surface must remain wet for the specified period.
  • Change cleaning cloths frequently, especially when soiled or moving between different areas like the bed space and bathroom.
• Prioritize High-Touch Surfaces: Pay special attention to items frequently touched by the resident and staff.
  • Door handles and light switches
  • Bed rails, bed controls, and call bells
  • Over-bed tables, remotes, and monitors
  • Chairs and counters
• Clean the Bathroom: The resident's bathroom should be cleaned last to prevent spreading germs to the rest of the room. Use a separate set of cloths for the bathroom. Disinfect the toilet, sink, faucet, and any grab bars.
• Clean the Floors: Finally, clean the floors by sweeping, vacuuming, and then mopping. Work from the back of the room towards the exit. Use fresh mop heads for each room to prevent cross-contamination. Place a wet floor sign as a safety precaution.

Comparison of Routine vs. Terminal Cleaning Procedures

Feature	Routine (Daily) Cleaning	Terminal (Discharge) Cleaning
Timing	Performed regularly while the resident is occupying the room.	Performed when a resident is discharged, transferred, or deceased.
Intensity	Focuses on high-touch surfaces and general tidiness.	Deep, comprehensive clean of all surfaces, equipment, and furnishings.
High-Touch Surfaces	Daily cleaning and disinfection.	Comprehensive cleaning and disinfection of all high-touch surfaces.
Low-Touch Surfaces	Generally not addressed daily, only if visibly soiled.	Thoroughly cleaned and disinfected, including walls, ceilings, and vents.
Linens	Change bed linens on a regular schedule.	Remove and launder all linens, including bed curtains and window treatments.
Personal Items	Avoid touching or moving personal items unless requested.	Safely pack or dispose of all personal care items.
Reusable Equipment	Spot clean and disinfect as needed.	Thoroughly reprocess and disinfect all reusable medical equipment.
Purpose	Reduces daily microbial load; maintains sanitation.	Eradicates all potential pathogens; prepares room for new resident.

Conclusion

By following standardized and systematic protocols for both routine and terminal cleaning, care staff can significantly reduce the risk of infection and provide a safe, sanitary, and respectful living space for residents. Adherence to these best practices—from proper hand hygiene and PPE use to cleaning from high-to-low and clean-to-dirty—is an essential responsibility that protects the health of everyone in the facility.

Additional Considerations

• Resident Comfort: Always be mindful of the resident's presence during cleaning, communicating with them respectfully and working efficiently.
• Chemical Safety: Ensure staff are properly trained on handling and storing cleaning chemicals. Never mix cleaning products, as this can produce toxic fumes.
• Regular Inspections: Visual checks and monitoring systems can help validate the effectiveness of cleaning protocols.
• Specialized Circumstances: Follow enhanced protocols for residents with specific infections, such as those requiring airborne or contact precautions.

For a general overview of infection control in long-term care settings, visit the Centers for Disease Control and Prevention (CDC) website. https://www.cdc.gov/longtermcare/index.html

Frequently Asked Questions

What is the correct order for cleaning a resident's room?

The correct order is to work from top to bottom and from the cleanest areas to the dirtiest. A common sequence is to remove trash and linens, perform high dusting, clean and disinfect surfaces (focusing on high-touch areas), and finally clean the floors, with the bathroom being cleaned last.

What is terminal cleaning in a resident's room?

Terminal cleaning is a deep, thorough cleaning and disinfection process performed after a resident has moved out. It covers all surfaces, equipment, and fixtures, ensuring the room is completely sanitized for the next occupant.

Why is it important to clean before disinfecting?

Cleaning removes the visible soil and organic matter that can deactivate disinfectants. Disinfectants are only effective when applied to a clean surface, so a two-step process ensures maximum germ-killing power.

What are high-touch surfaces in a resident's room?

High-touch surfaces are areas frequently touched by residents and staff. Examples include bed rails, call bells, light switches, door handles, remotes, and over-bed tables. These require daily cleaning and disinfection.

How often should a resident's room be cleaned?

Routine daily cleaning and disinfection should be performed daily, focusing on high-touch surfaces. Deeper, terminal cleaning is performed only after a resident's departure.

How should soiled linens be handled to prevent contamination?

Soiled linens should be handled with gloves and carefully rolled up to avoid agitating particles into the air. They should be placed in a designated laundry bag and carried away from the body to prevent cross-contamination.

What are best practices for using cleaning cloths and mops?

To prevent spreading germs, use separate, clean microfiber cloths and mop heads for each room. Change them immediately if they become visibly soiled. Never re-dip a soiled cloth into a cleaning solution bucket.