Cleaning Equipment and Clinical Spaces

The term “environmental cleaning” refers to the cleaning and disinfection of both the physical environment and the equipment used for the provision of care. Maintaining a clean environment and clean equipment minimizes microbial contamination and interrupts the transmission of pathogens. It is an essential component of infection prevention and control (IPAC).

Cleaning and Disinfection of Medical Equipment and Devices

"If there is a discrepancy between the reprocessing level recommended by the manufacturer and the intended use of the instrument by Spaulding’s criteria, the higher level of disinfection/sterilization must be used." ⁽¹⁾

Most of the equipment used by midwives can be classified as non-critical or critical.

Non-critical devices do not directly touch the client or touch only intact skin (e.g. stethoscope)
Critical devices are those that enter body tissues, allowing for direct contact with the bloodstream (e.g. needle driver).

Single-use medical devices are identified by the image of a crossed out 2 and are intended only for use on a single client. They cannot be cleaned and disinfected

All reusable clinical equipment must be effectively cleaned and disinfected according to Spaulding’s Classification of Equipment and Medical Devices – low-level disinfection (LLD), high-level disinfection (HLD), or sterilization. Since the hands of health care workers touching non-critical items can contribute to transmission of microorganisms, it is important to ensure that equipment and devices touched by care providers during the provision of care and the health care environment are effectively cleaned and disinfected, in addition to performing hand hygiene.

Choosing the Right Disinfectant

The choice of disinfectant agent depends on the level of disinfection required (e.g. LLD or HLD), the surface area of the device, the type of microorganism being targeted (i.e. routine disinfection versus disinfection following a specific outbreak such as norovirus or C. difficile) and the compatibility with the surface/material being cleaned. The intended use of the product should also be considered when selecting a disinfectant. Phenolic disinfectants should not be used in areas or on equipment used for newborn care.^(2,3)

To achieve disinfection, product must remain wet for the prescribed minimum contact time.

Wear appropriate personal protective equipment (PPE) when using disinfectants and handling contaminated medical devices, and ensure cleaning products have a drug identification number (DIN) from Health Canada. Practice groups are required to comply with the workplace hazardous materials information system (WHMIS) requirements. This includes appropriate labeling, handling and storage of hazardous materials (e.g. cleaning products), and ensuring safety data sheets are accessible to workers.Some disinfectants are marketed as a one-step cleaner and disinfectant, others as a two-step (separate cleaning and disinfection). It is important to follow the manufacturer’s instructions when using cleaning and disinfectant agents. If organic soil is present, a two-step process involving cleaning followed by disinfection is required regardless of the product used or kill claim reported, as organic material may inactivate a disinfectant. (3) It is also important to ensure the disinfectant remains wet on the surface being disinfected for the required wet contact time. Products requiring a wet contact time beyond five minutes are not practical to use at the point of care due to the time and repeated applications required.

Cleaning of Equipment

IPAC is one of many factors to consider when purchasing new equipment. Checkout the AOM's Equipment Purchasing Guide. The following resources have been developed or are in development to support midwives to clean and disinfect their medical equipment and devices. These resources focus on the cleaning and disinfection of reusable equipment; information on sterilization is available under Instrument Reprocessing.

Products for Cleaning Midwifery Equipment – Considerations and guidance for commonly-used disinfectants.
Midwifery Equipment Cleaning Tips – A comprehensive list of equipment used by midwives and the minimum cleaning and disinfection or sterilization and frequency of cleaning required for each equipment.
Home Birth Equipment Cleaning Video – A visual guidance on the appropriate transport, setup and cleaning and disinfection of newborn care equipment used during home births.
Guidelines for Water Immersion and Water Birth – Guidance adopted by the AOM on cleaning and disinfecting birth pools and considerations when providing informed choice discussions.
Pulse Oximeter Maintenance and Cleaning – AOM resource that provides guidance on cleaning and maintaining four most common neonatal pulse oximeters based on provincial standards and manufacturer instructions.
Purchasing Equipment - IPAC considerations when purchasing new equipment

Cleaning of Clinic Office

Depending on the use of space, all cleaning of the clinic office is categorized as either the cleaning of a public space (e.g. waiting room, staff offices, lunch rooms) or the cleaning of a clinical space (e.g. clinic rooms, washrooms, reprocessing area). The Provincial Infectious Diseases Advisory Council (PIDAC) states that public spaces should be cleaned to the level of a “Hotel Clean” – a basic level of cleaning based on visual assessment. (3) Clinical space cleaning involves a Hotel Clean plus disinfection and other infection control measures such as increased frequency of cleaning and auditing. (2)

In this context, cleaning refers to the removal of visible soil and requires the use of water, detergents and friction to physically remove soil (e.g. dirt, organic material etc.) from surfaces. Since cleaning does not kill microorganisms, no minimum wet contact time is required. Disinfection is a process that will kill or inactivate most disease-causing microorganisms (e.g. bacteria, virus, and fungus) but unlike sterilization, it may not kill all bacterial spores.

The following resources are in development to provide guidance on the cleaning and maintenance of the clinic office.

Clinic Cleaning Video – A visual guidance on cleaning of clinic rooms and non-critical equipment used during clinic appointments.
Template Office Cleaning Checklist – A template cleaning checklist to provide cleaning staff to ensure the clinic office is cleaned according to IPAC requirements and the practice group’s needs.
Template IPAC Policies (in the Infection Prevention and Control section) – Template policies developed by the AOM that can be adapted by practice groups to meet their specific environmental cleaning needs.
Laundry – summary of relevant guidelines on laundry and infection prevention and control.

References

Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee (PIDAC). Best Practices for Cleaning, Disinfection and Sterilization of medical Equipment/Devices in All Health Care Settings. 3 ed. [Internet] Toronto, ON: Queen’s Printer for Ontario. May 2013. [cited 2018 Mar 21]
Ontario Agency for Health Protection and Promotion (Public Health Ontario), Provincial Infectious Diseases Advisory Committee (PIDAC). Routine Practices and Additional Precautions In All Health Care Settings. 3 ed. [Internet] Toronto, ON: Queen’s Printer for Ontario. Nov 2012. [cited 2018 Mar 21]
Ontario Agency for Health Protection and Promotion (Public Health Ontario). Provincial Infectious Diseases Advisory Committee (PIDAC). Infection Prevention and Control for Clinical Office Practice. 2 ed. [Internet] Toronto, ON: Queen’s Printer for Ontario. April 2015. [cited 2018 Apr 1]