A Clean Sweep: Sanitation in Urgent Care Centers

Your focus at work is patient care. Cleaning and sanitation of the urgent care center (UCC) take a distant priority in comparison to the health of your clients. But that doesn’t mean it isn’t important — a well-kept facility can reduce infection risk and promote a successful business.

“Urgent care centers present special infection prevention and control challenges due to patient mix, acuity, and the practice environment itself,” says Jean Fleming, RN, MPM, CIC, clinical director of infection prevention and education for Professional Disposables International, Inc. Because UCCs serve such a variety of patients, it’s a challenge to identify the range of potentially transmissible infections that may be recognized or unrecognized among patients. These infections can put healthcare workers and patients at risk.

“Appropriate triage and application of precautions to avoid transmission to others is critical,” Fleming advises. “Upon arrival to an urgent care center, patients should be assessed for symptoms of productive cough, diarrhea, undiagnosed rash, bleeding, and wound or eye drainage. As soon as possible, patients with these conditions should be placed in a separate exam room away from others to avoid potential exposure to others and contamination to the general environment.”

The basic principles of infection prevention and control are the same regardless of the setting — be it urgent care or acute emergency care. Thus, good hand hygiene and cleaning and disinfecting the facility are essential. “The environment plays a role in transmission of infection since anything that moves from patient to patient (hands, equipment) can act as a vehicle for transmission. Infection transmission occurs when the gloved or ungloved hands of healthcare workers come in contact with a contaminated surface and/or there is patient contact with contaminated surfaces or medical equipment,” says Fleming.

When determining what cleaning and disinfection plan your UCC will use, you must take into account that different seasons and patient cohorts may require different approaches — depending on the extent and degree of contamination. “Spills of blood or surfaces contaminated with visible blood and body fluids require immediate attention. Environmental surfaces and medical equipment/devices that are frequently touched and/or shared between patients require cleaning or disinfection between each patient use and/or at least on a daily basis. Other surfaces may require cleaning less often, such as on a weekly basis,” she says. “Establishing protocols is based on the risk for transmission of pathogenic microorganisms. It is critical to have cleaning and disinfection schedules in place that list items/areas to be cleaned or disinfected, frequency for performing the task, and person responsible for carrying out assignments.”

“Urgent care centers present special challenges due to patient mix,” agrees Anita Earl, RN, BSN, president of IPEC Consultants, Inc., which provides infection prevention and control consulting services to tertiary care and community healthcare delivery systems, as well as healthcare product manufacturing such as Metrex Research Corporation.

The challenges that UCCs see include flu season and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) — which can increase the need to address infection prevention efforts. And, Earl adds, children with infections and contagious conditions are frequently seen in this setting.

“Infection control practices have long been recognized as an important means of preventing transmission of infectious agents,” she adds. “Written policies and procedures concerning infection prevention and control should be developed and incorporated into the facility’s safety program and available to the staff at all times. Education regarding infection prevention and control should be implemented and evaluated on a regular basis.”

All staff members need to undergo this education — so they each understand the importance of proper hand hygiene practices, and environmental and equipment decontamination processes. Regardless of the center’s clientele, infection prevention and awareness should be a priority. “Equally important is the understanding of who is cleaning what — and specify the responsibilities!” Earl adds.

“The greatest challenge in the urgent care or any healthcare environment is to reduce and eliminate the spread of infectious disease, in addition to the most important element, which is always a stringent handwashing protocol,” points out Peter Sheldon, vice president of operations for Coverall Cleaning Concepts, a commercial cleaning franchising company.

A cleaning program that focuses on the strict fundamentals of hygienic and aseptic cleaning can reduce the spread of harmful pathogens, he says. “In today’s world, with growing pathogenic threats like MRSA, vancomycin-resistant Enterococcus (VRE) and Clostridium difficile, it is no longer subjective appearance that is the primary concern of healthcare facilities," he adds. "Rather, it is an effective infection control program that includes the process of cleaning at the unseen microbial level that has the most impact on these facilities."

Cross-contamination is a key issue in healthcare facilities, especially those with high traffic, observes Chris Kosobud, customer marketing manager for Kimberly-Clark Professional. “Germs can be spread from person to person — either through droplet contamination or through surface contamination, when someone touches a surface that has previously been contaminated by another person. Respiratory hygiene is another key issue to watch — especially during the height of cold and flu season. Patients with severe cold and flu symptoms may be asked to don a breathing mask while at the center. Also, patients should be encouraged to use a disposable tissue when coughing and to discard that tissue after use.”

Best Practices

Hand hygiene is one of the most important means of preventing transmission of infectious agents. “Hands are easily contaminated during the process of providing patient care or contact with environmental surfaces, especially in close proximity to the patient,” Earl says. “The importance of reinforcing hand hygiene for the care of all patients or their potentially contaminated environment and reinforcing the importance of good environmental cleaning in this setting should not be underestimated.”

The cornerstone of any effective infection control system begins with hand hygiene and includes the prudent use of hospital-grade, EPA-registered disinfectant chemistry to kill the potentially dangerous pathogens, combined with cleaning systems and technology that ensure adequate soil and matter removal down to the microbial level, Sheldon observes. “Things like no-touch cleaning systems, color-coded microfiber cleaning implements to eliminate cross-contamination, and electrostatic dusting tools are all key components to an effective cleaning system,” Sheldon adds. “The key is to get rid of the dead cells you have killed with the chemistry so they do not remain as a future food source for new organisms.”

As for surface sanitation, it’s important for immediate care staff members to inspect the materials and methods they use for environmental surface wiping. “Recent studies have shown that the standard method used for years — i.e., a cloth rag dipped into a bucket of cleaning solution — does not provide optimum surface disinfection. It’s better to use a wiping material that is compatible with bleach, quats or other disinfectants to make sure that the intended amount of disinfectant agent reaches the surface,” says Kosobud.

Patient treatment areas should have sinks and patient waiting areas should have alcohol-based hand hygiene products and tissues accessible for patient use, Fleming says.

High-touch areas like doorknobs, light switches, bed rails, and bedside tables need more frequent cleaning and sanitation. “To make this job easier, some facilities are adopting disinfecting wiping systems that are portable, with the wiper and disinfectant contained in one bucket or canister — similar to the way baby wipes are packaged. This format is easier to carry to different germ ‘hot spots’ throughout the facility. It’s best to use a wiping material that is compatible with bleach, quats or other disinfectants to make sure that the intended amount of disinfectant agent reaches the surface,” Kosobud explains.

“In addition to medical equipment, telephones, computer keyboards and the mouse are examples of frequently touched surfaces in urgent care that are often forgotten and should be disinfected on a daily basis and when obvious contamination occurs by users with cold and flu symptoms,” Fleming says.

All patient care equipment should be cleaned at least daily while in use or when visibly contaminated, and should be stored where it will not become contaminated, Earl says. Updated guidelines may soon be available in the updated CDC HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities, which is expected to be released shortly and published in the Morbidity and Mortality Weekly Report.

Pest Control

“The biggest challenge to pest management is also your business’ biggest asset — the number of people walking in your door,” says Patrick T. Copps, MS, BCE, technical services manager for Orkin, Inc. Copps is a board-certified entomologist in urban and industrial entomology.

“While you want a steady flow of patients, the high traffic of people coming and going all day can make it easy for pests to slip in,” he explains. Pests seek the three elements they need to survive — food, water and shelter. “By mitigating access to these elements through planned sanitation and an ongoing maintenance program, you reduce the likelihood that pests will find these elements in your facility,” Copps says. “Most pests only need small amounts of food and water to survive, so it’s important to keep a regular sanitation schedule and fix any facility maintenance issues, such as leaky pipes, quickly.”

There should be a written protocol in place for pest management perspective, and staff members need to be involved in it. A pest management provider can educate the staff on how to identify and report pest problems and/or conditions conducive to pests.

“Cockroaches and flies cause the most concern in immediate care facilities,” says Copps. “Roaches can carry an average of 25 different disease-producing bacteria that can lead to illnesses such as diarrhea, food poisoning, pneumonia and leprosy. And flies are no less unhygienic. In fact, it is actually less sanitary for a fly to land on a surface than for a cockroach to walk across it. Flies’ bodies can be coated in bacteria, sloughing it off every time they land and potentially spreading common sources of illnesses such as E. coli, Shigella and Staphylococcus. Flies can carry many disease organisms inside their bodies, and since they feed on or ‘taste’ everything they land on, these organisms also can be transferred to food or examining tables, etc.”

“Simple practices such as vacuuming daily and the immediate removal of spills and standing water can discourage pests from taking up residence in your facility,” adds Copps. “Since most pests look for a daily food and water source, daily sanitation is a must. In addition, conduct a deep cleaning of your facility once or twice a year to get to those hard-to-reach areas behind and under equipment.”

Ultimately, he says, it’s important to ensure that your sanitation program incorporates these procedures:

• Line all trash receptacles and make sure they are covered with a tightly fitting lid.

• Empty all trash containers daily and dispose of trash properly — do not let trash or debris pile up near entrances to the building.

• Work with your waste management company to clean and rotate dumpsters frequently, and keep Dumpsters as far from your facility as possible.

• Install weather-stripping around doors and windows, and use door sweeps to provide a secure seal from the outside.

• Cockroaches only need a 1/16 inch gap to enter, so seal even small cracks.

• Install fly lights in building entrances.

• Test the airflow of your building to make sure you have positive airflow — air that blows out the door rather than in — which can prevent flying pests from entering.

“The key to keeping trash and pests under control is to collect trash from all treatment rooms, offices, waiting areas and bathrooms on a daily basis,” Fleming says. “There should be designated trash receptacles in patient treatment areas for regular (non infectious) and infectious wastes as defined by local and state authorities. No trash should be left in trash receptacles in treatment rooms, offices, bathrooms or patient waiting rooms from one day to the next.”

At the end of the day, you’ll have a more profitable business if you follow these simple tips. Keeping your facility clean and pest-free will ensure that the clinic appears — and is — a safe environment. icb

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines

Read Comments [0]