Question: I am very concerned regarding the lack of routine housekeeping services that are provided to the CPD department. We used to have a housekeeping aid assigned to the support services departments on a daily basis. Recently our hospital engaged contract management services for the housekeeping department as a cost savings initiative. As a result of this change the new manager has reassigned our housekeeper to other areas and CPD no longer gets the depth of housekeeping services we used to get or that I feel is necessary.

We now only receive trash removal once a day, the floors are washed every three days (twice a week), rest rooms are also cleaned twice a week, no other services are provided and the staff is expected to keep areas clean and tidy between housekeeping services. I have been trying to convince the housekeeping manager that CPD requires more extensive cleaning services on a daily basis. Are there any standards or guidelines I can use to support my case?

Answer: You are right to be concerned relative to the cuts in the housekeeping services that are provided to your department. There is evidence that cleaning reduces microbial growth and thus contributes to the reduction of microbial transmission. Obviously the decontamination area is considered a "dirty room"; work surfaces, equipment, floors and the entire environment is subject to contaminants and if not controlled and maintained in a clean state could present a high risk for microbial breeding and spread of contaminants placing HCWs and patients in danger. It is also imperative that the processing and sterile storage work areas, which are considered "clean rooms" be maintained clean, dust free and secure to preserve the integrity of clean and sterile devices used in patient care.

There are many published recommendations relative to the environmental control issues for the CPD areas. For more detailed information I suggest you obtain and review documents published by Association for the Advancement of Medical Instrumentation (AAMI.org), American Association of Healthcare Central Service Practitioners (ASHCSP.org) and the International Association of Healthcare Central Service Materiel Managers (IAHCSMM.org). These recommendations and documents address not only cleaning but important factors such as traffic control, work flow, temperature, humidity, air flow, work techniques, sterility maintenance principles and the like. The AAMI standard ST46, 3.4 which addresses housekeeping procedures states, "Housekeeping procedures in areas used for any aspect of decontamination, preparation, or sterilization should be the same as those used to clean operating and delivery rooms. At least daily, floors and horizontal work surfaces should be cleaned. Other surfaces such as walls, storage shelves and air intake and return ducts, should be cleaned on a regularly scheduled basis and more often as needed. Care should be taken to avoid compromising the integrity of packaging during cleaning procedures. Special attention should be paid to the sequence of cleaning, to avoid transferring contaminants from "dirty" to "clean" areas and surfaces. It’s a good practice to provide separate housekeeping facilities for the decontamination and clean areas."

Question: I am the infection control nurse at a large medical center and a member of our product evaluation committee. We are in the process of considering a change in cleaning detergents used in environmental services and CPD. In reviewing some data of the cleaning agents proposed for use in the CPD auto washers I was quite surprised to see many offered no germicidal properties or claims. I have always been of the opinion that the use of germicidal detergents was essential to the decontamination/disinfection processes. Why would any manufacturer offer cleaning agents for this purpose that have no germicidal affects?

Answer: It is very important that we first understand that the decontamination and disinfection processes are two distinctly different and separate processes.

Cleaning or decontamination is the process rendering soiled medical devices safe for further handling and reprocessing. It includes the reduction of organisms and other contaminants from medical devices. The Association for the Advancement of Medical Instrumentation (AAMI ST35) defines cleaning as "the removal, usually with detergent and water, of adherent visible soil such as blood, protein substances and other debris, from the surfaces, crevices, serrations, joints, and lumens of instruments, devices, and equipment by a manual or mechanical process which prepares the items for safe handling and/or further decontamination."

The focus of decontamination is basically the physical removal of soils and contaminants. Detergents are specially formulated and include properties which attack and breakdown organic soils to facilitate easier and thorough removal of soil with the mechanical action, agitation or friction applied during manual or automatic washing processes. Effective cleaning or decontamination is the first step in the reprocessing of medical devices. Items to be disinfected and or sterilized must therefore be cleaned first. Disinfection is the process of inactivating or destroying microbial organisms.

In CPD applications disinfection is achieved via chemical or thermal processes. As you of course know there are various levels of disinfection depending on the intended use of the medical device. Therefore the appropriate chemical with germicidal claims must be selected and applied for the prescribed exposure time for the level of disinfections you require. Thermal disinfection is the destruction of organisms via exposure to high temperatures, in CPD some automated washers are classified as washer disinfectors/sterilizers and items processed in this equipment are exposed to elevated temperatures which destroy living organisms. It is important to note that most washer decontaminators are class one medical devices and are cleared for low level disinfection. The use of germicidal detergents is not necessary incleaning/decontamination of medical devices. What is important is that soil be thoroughly removed from devices to allow intimate and direct contact of the sterilant during sterilization. It is therefore important that the cleaning agents utilized in CPD be selected and carefully evaluated for effective performance. These agents should contain the proper additives, properties, and enzymatics appropriate to the types of organic soils found on medical devices. HPN