Cleaning of the Environment

In healthcare settings, microorganisms (bacteria, fungi, viruses) are present throughout the environment and can cause infection. The environment can serve as a breeding ground for these organisms. Cleaning and disinfecting surfaces and medical equipment, especially those that are frequently touched, is important to decrease and prevent the spread of these organisms to people.

It is important to develop procedures for routine care, cleaning, and disinfection of environmental surfaces, especially frequently touched surfaces in patient/resident-care areas.

Important Environmental Cleaning Terms

  • Cleaning = removal of all visible dust, soil, and any other foreign material
  • Decontamination = removal of disease-producing microbes to make safe for handling
  • Disinfection = process that destroys nearly all disease-producing organisms, except spores
    • Involves the use of a chemical or physical agent called a disinfectant
    • Classified as high-level, intermediate-level, or low-level
    • Cannot disinfect without cleaning first
  • Sterilization = process that destroys microorganisms and spores
    • Involves the use of a physical process such as steam and pressure, dry heat, or a chemical process

For Healthcare Providers

General tips on cleaning and disinfection:

  1. Only use disinfectants registered with the U.S. Environmental Protection Agency (EPA).
  2. Directions for cleaners and disinfectants should be reviewed for use, dilution, contact time, and shelf life.
    1. Contact time: amount of time needed for the chemical to come in contact with the microorganism so that a significant number of organisms are killed.
  3. Housekeeping surfaces (e.g., floors, table tops) and other environmental surfaces should be cleaned and disinfected regularly, when spills occur, and when visibly dirty. Medical equipment that is shared should be cleaned and disinfected between patients. Follow your facility’s schedule for routine cleaning and disinfection and for terminal cleaning of rooms when preparing the room for the next patient.
  4. Use a disinfectant appropriate for the situation.
    1. For example: C. difficile and norovirus contaminated areas may need different cleaners and disinfectants
  5. How to prepare a solution using household bleach (5.25%-6.15% hypochlorite):
    1. 1:10 dilution
      1. 1 part bleach to 9 parts water
      2. 1 ½ cups bleach in 1 gallon water
      3. Example of when this dilution is recommended: for routine environmental disinfection in units with high rates of endemic Clostridium difficile infection or in a Clostridium difficile outbreak setting
    2. 1:100 dilution
      1. 1 part bleach to 99 parts water
      2.  1/4 cup bleach in 1 gallon water
      3. Example of when this dilution is recommended: for cleaning small blood spills (i.e. a few drops of blood)

Different types of equipment and environmental surfaces need different levels of cleaning, disinfection, or sterilization depending on the use of the item/surface and the risk of becoming infected with germs that may be on the item/surface.

  1. Critical items are items that enter normally sterile tissue or the vascular system or through which a sterile body fluid (e.g., blood) flows. These items are associated with high risk of infection if they are contaminated with any microorganism and must be sterilized before using. Examples include surgical instruments, cardiac and urinary catheters, and implants.
  2. Semicritical items are items that contact mucous membranes (e.g., eyes, nose, or mouth) or non-intact skin. At a minimum, semicritical items require high-level disinfection using chemical disinfectants and rinsing with sterile water. Examples include respiratory therapy and anesthesia equipment, some endoscopes, cystoscopes, and laryngoscope blades.
  3. Noncritical items are items that have contact with intact skin but not mucous membranes and are associated with little risk of spreading germs. Noncritical items require at least low-level disinfection. Noncritical care items include bedpans, blood pressure cuffs, blood glucometers, crutches, and computers. Noncritical environmental surfaces include bed rails, tray tables, bedside tables, walls, floors, toilets, sinks, and furniture.

Tools and Resources

Ambulatory surgical centers

Checklists for monitoring compliance with cleaning practices

Environmental Protection Agency (EPA)

Fact sheets

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