Environmental hygiene in healthcare

Thorough environmental hygiene is important for the prevention of transmission of infectious diseases within healthcare settings. Environmental hygiene encompasses effective cleaning of surfaces using appropriate products, decontamination of medical equipment and devices used in patient-care procedures, safe and appropriate handling of sharps, blood and body fluid spills, waste and linen.

See below for more information.

Environmental surface cleaning

The role of environmental cleaning is to reduce the number of infectious agents that may be present on surfaces and minimise the risk of transfer of micro-organisms from one person/object to another, thereby reducing the risk of cross-infection.

Cleaning is a process which intends to physically remove foreign material (for example dust, soil, blood, secretions, excretions and micro-organisms) from a surface or an object through the use of water, detergent and mechanical action (friction).

Cleaning standards

The SA Health Cleaning Standard (PDF 2MB) has been developed to establish a state-wide approach to environmental cleaning in South Australian healthcare facilities. The Standard contains information on various topics such as infectious disease transmission, cleaning chemicals, equipment and techniques, a cleaning schedule, an environmental hygiene program and audit system. There are also additional separate appendices available in the SA Health Cleaning Standard Toolkit as below:

Cleaning standard toolkit

Supporting resources for smaller facilities

The Australian Commission in Safety and Quality in Health Care (ACSQHC) have produced a suite of resources to support smaller healthcare facilities in infection prevention and control activities.

The ACSQHC acknowledge that the documents provide example risk assessment tables and as such there are differences between the ACSQHC and SA Health Cleaning Standard functional area table.

Environmental cleaning principles for smaller health organisations

This resource suitable for smaller health service organisations, such as, but not limited to rural and remote settings, aged care facilities, general medical and dental practices, outpatients or day only procedural services and rehabilitation services.

Environmental cleaning: Information for cleaners

The Environmental cleaning: Information for cleaners fact sheet has been developed specially to support the important role of cleaning staff in all health service organisations, aged care and disability services, clinics, general medical and dental practices.

Management of the environment during construction and renovation

Environmental disturbances which occur during construction or renovation projects pose both airborne and waterborne risks particularly to persons with poorly functioning immune systems. It is essential that all key stakeholders are included in all stages of the project to minimise the risk of vulnerable persons acquiring a potentially serious infection within the healthcare setting.

The Infection prevention and control during construction and renovation and associated toolkit (PDF 255KB) has been developed to establish a state-wide approach to the management of construction and renovation projects.

Optimising ventilation

The Australian Commission on Safety and Quality in Health Care (ACSQHC) Optimising ventilation for infection prevention and control in healthcare settings guideline has been developed for health service organisations to explain the importance of effective ventilation systems for preventing and controlling infections and how ventilation risks can be mitigated to improve patient and workforce safety.

Decontamination of medical equipment and devices

Used patient care equipment should be handled in a manner that prevents skin and mucous membrane exposure, contamination of clothing and transfer of microorganisms to other patients and the environment.

Items of shared patient equipment such as infusion pumps, oximeters, BP cuffs, commodes must be cleaned and decontaminated prior to use on another patient. The method to be used should be in line with national and local infection control guidelines and the manufacturer’s instructions.

SA Health has issued information and advice on the management of heater-cooler devices.

See Reprocessing of medical devices for information on the reprocessing of reusable medical devices.

Management of spills

Spills must be removed immediately or as soon as practicable, and the area cleaned and disinfected dependent upon the setting and volume of spill. In patient care areas small spills can be easily managed by wiping the area immediately with a paper towel and then cleaning the area with detergent and water. Large spills (over 10cm) containing blood or body fluids should be contained, and in addition to cleaning as above, a chlorine-based disinfectant should be used. There are commercially available spill kits which facilitate the process.

Personal protective equipment, including gloves as a minimum, must be worn when cleaning up blood and body substance spills.

Safe handling of sharps

It is important that all staff are aware of the inherent risk of injury associated with the use of sharps such as needles, scalpels and lancets. When handling sharps the following principles apply:

  • the person using the sharp is responsible for its safe disposal
  • dispose of the sharp immediately following its use and at the point of care
  • dispose of all sharps in designated puncture resistant containers that conform to relevant Australian Standards (AS/NZS 4261:1994 reusable; AS 4031:1992 non-reusable)
  • dispose of sharps disposal containers when they are ¾ full or reach the specified fill line, seal appropriately and place in the clinical waste stream
  • never pass sharps by hand between health care workers
  • never recap used needles unless an approved recapping device is used
  • never bend, break or otherwise manipulate by hand a needle from a syringe.

Safe handling of waste

It is important that all staff dealing with waste adopt procedures that minimise risk to both themselves and to their environment.

Medical waste is defined as waste consisting of all sharps, human tissue including bone, any liquid body fluid, and laboratory specimens.

Dressings and bandages, materials that are only stained or have had minimal contact with body substances, disposable nappies, incontinence pads or sanitary napkins are not regarded as medical waste and can be disposed of in general waste.

  • appropriate personal protection equipment (PPE) must be worn when handling all waste, with due care to protect against exposure to blood and body fluids, and injury
  • waste is to be segregated at the point of generation into general, clinical, cytotoxic, radioactive and hazardous streams
  • there is a legal obligation to classify and contain waste according to the facility waste management plan and State Regulations
  • healthcare workers should be trained in the correct procedures for waste handling.

Safe handling of laundry and linen

All used linen should be handled with care to avoid dispersal of microorganisms into the environment and to avoid contact with staff clothing. The following principles apply for linen used by all patients regardless of their infectious status:

  • all used linen is considered contaminated therefore minimal handling is recommended
  • appropriate PPE must be worn during the handling of soiled linen to prevent skin and mucous membrane exposure to blood and body fluids
  • dispose of all linen into an appropriate linen container at the point of care
  • linen which is heavily contaminated with blood and/or other body fluids which could leak must be contained by a leak-proof bag and secured prior to transport
  • hand hygiene must be performed following the handling of all used linen.

Control of Legionella in water and ice machines

Water is the natural habitat of many Legionella species. These bacteria cannot be eliminated from water systems, but need to be controlled so that they do not present a risk to vulnerable people in the community or in care facilities.

All healthcare and other care facilities that house vulnerable people such as the aged, or those with weakened immune systems, should have a Legionella management plan in place that identifies the potential hazards and mitigates the risk.

Useful information to inform the plan can be found in the national Guidelines for Legionella Control.

SA Health also have a fact sheet on managing the risks associated with chilled water and ice machines in care facilities.

For further information

For further information on environmental hygiene contact the SA Health’s Infection Control Service on (08) 7425 7161.