Environmental hygiene is a vital part of infection control, and cleaning professionals have the potential to make an enormous impact on patient safety by achieving excellent disinfection using hypochlorite-based products for terminal cleaning and by focusing on such high-risk areas as bathrooms, waiting areas and ICUs.

The process of both daily and cleaning and disinfecting is of the utmost importance to ensure patient safety and prevent the spread of germs that cause HAIs. However, in the past, there's been some confusion around "terminal" cleaning — what it is, when it is used and why it is important.

According to the Association for the Healthcare Environment's (AHE's) Practice Guidance for Healthcare Environmental Cleaning, terminal or discharge cleaning refers to the comprehensive, deep cleaning of a patient room at the time of discharge from a health care setting or upon termination of transmission-based precaution policies in place at a given facility. This is meant to render the area safe and ready for the next patient.

The environmental infection prevention strategy must include at a minimum:
•    cleaning and disinfection of surfaces touched by patients, health care providers and visitors; and the
•    cleaning of environmental surfaces and visibly soiled surfaces, followed by disinfection in accordance with the facility's discharge procedures.

Despite the important role that terminal cleaning plays in patient safety, many studies have shown that the actual cleaning performed by hospital staff is suboptimal, with only about half of surfaces getting wiped down when they should, according to an article titled "Identifying opportunities to enhance environmental cleaning in 23 acute care hospitals" in the January 2008 edition of Infection Control and Hospital Epidemiology (ICHE).

When performing terminal cleaning, cleaning professionals can reference the following key steps:

Practice hand hygiene and use personal protective equipment (PPE). When preparing to enter a known or suspected C. difficile room, ES staff first should perform hand hygiene per their hospital's hand-hygiene policy and then don PPE such as gloves, gowns and masks before entering the room.

Clean high-touch surfaces. Cleaning staff should begin by cleaning high-touch surfaces with an EPA-registered sporicidal disinfectant. High-touch areas include door handles and knobs, light switches, call buttons, tray tables, bedrails and phones.

Dust the room. Staff should follow their facility guidelines for a cleaning path, such as cleaning clockwise, top to bottom. They should start with overhead lights. Next, they should damp dust the television, television stand, lights, bed frame, mattress covers, pillows and blood pressure cuffs and remove unused linen and other such items.

Clean the bathroom. It is important to remember that all patient bathrooms are high-risk areas frequently exposed to potentially infectious materials including C. difficile spores. Careful cleaning and disinfection with an EPA-registered sporicidal disinfectant should be included as part of terminal cleaning in all patient bathrooms. Staff should pay careful attention to disinfecting bathroom surfaces such as doorknobs and handrails, mirrors, tubs and showers, faucets, sinks and toilet levers, surfaces and seats.

Clean the floors. After cleaning the bathroom surfaces, the floor should be cleaned, first by dust-mopping and then wet-mopping. After daily floor cleaning is complete, staff should exit the room and remove trash, mops and soiled curtains and linens. They should also discard wipes and cloths and dispose of PPE materials.

Prep for the next patient. After terminal cleaning is complete, staff should wash hands with soap and water and re-enter the room to remake the bed with clean linens, replace pillows, mattresses, pillow covers and mattress covers as necessary. They also should replace privacy curtains.

These excerpts originally appeared on Health Facilities Management.