With the current ongoing pandemic, there has been heightened concerns and new protocols to address this tiny pathogen that has managed to disrupt the entire world. Pervasive yet invisible, efforts have been greatly increased to ensure safety. In this article we will explore one of the emerging areas of change: terminal cleaning.

Terminal cleaning is a complete and enhanced cleaning procedure that decontaminates an area following discharge or transfer of a patient with an infectious/communicable disease, sometimes also referred to as an ‘infectious clean’. Terminal cleaning requires both thorough cleaning and disinfection for environmental decontamination.

Terminal cleaning is used primarily in a hospital setting following a patient’s discharge. Typically, the patient would have been infected by an antibiotic-resistant disease, and so proper protocol and procedure must be followed in this type of setting.

In order to reduce and eliminate the spread of any harmful bacteria or disease from spreading to the next patient, a professional cleaning crew would remove all objects from the room and thoroughly clean each surface and object properly. Disinfection must also be used as well. The Australian Government offers some protocol in this regard. Cleaning should be followed by or combined with a disinfectant process (see 2-step clean and 2-in-1 step clean below).

Ensure room is prepared prior to cleaning, remove medical equipment and patient used items.

  • Wear PPE – surgical mask, protective eyewear and gloves
  • Change bed screens and curtains (including disposable curtains/screens) that are soiled or contaminated
  • Damp dust all surfaces, furniture and fittings
  • Clean windows, sills and frames
  • Clean all surfaces of bed and mattress
  • Mop floor
  • Remove PPE and perform hand hygiene
  • Clean all cleaning equipment and return it to the cleaners’ room or storage area, discard any waste
  • Perform hand hygiene

2-step clean

Physical cleaning with detergent followed by disinfection with a TGA-listed hospital-grade disinfectant with activity against viruses (according to label/product information) or a chlorine based product such as sodium hypochlorite.

2-in-1 clean

A physical clean using a combined detergent and TGA-listed hospital-grade disinfectant with activity against viruses (according to label/product information) or a chlorine-based product such as sodium hypochlorite, where indicated for use i.e. a combined detergent/disinfectant wipe or solution.

When cleaning areas that are highly shared or touched, the CDC offers some guidance and protocol for this.

Proceed From Cleaner To Dirtier

 

Depiction of hospital bedProceed from cleaner to dirtier areas to avoid spreading dirt and microorganisms. Examples include:

  • During terminal cleaning, clean low-touch surfaces before high-touch surfaces.
  • Clean patient areas (e.g., patient zones) before patient toilets.
  • Within a specified patient room, terminal cleaning should start with shared equipment and common surfaces, then proceed to surfaces and items touched during patient care that are outside of the patient zone, and finally to surfaces and items directly touched by the patient inside the patient zone (Figure 9). In other words, high-touch surfaces outside the patient zone should be cleaned before the high-touch surfaces inside the patient zone.
  • Clean general patient areas not under transmission-based precautions before those areas under transmission-based precautions.
  • Proceed in a systematic manner to avoid missing areas—for example, left to right or clockwise.

What you can do
Practicing good hand and sneeze/cough hygiene is the best defense against most viruses. You should:

  • wash your hands frequently with soap and water, before and after eating, and after going to the toilet
  • cover your cough and sneeze, dispose of tissues, and use alcohol-based hand sanitizer
  • if unwell, avoid contact with others (touching, kissing, hugging, and other intimate contact).

Sources

Cleaning Procedures
Terminal Cleaning of Operating Rooms what it really means
Environmental Cleaning and Disinfection Principles for covid-19
4 Ways to Improve Terminal Cleaning