clean

Cleaning Standards Hygiene
• Access up to date National Guidance on Cleaning Standards in
Healthcare
• Develop a comprehensive cleaning plan and schedules
• Identify colour coded cleaning equipment and products to be used in
healthcare and describe effective cleaning and storage of equipment
• Monitor standards of cleanliness in Primary Care Dental Practices
Beverly Lamb
Specialist Dental Infection Control Nurse

Cleanliness in Dental Practices
Achieving and maintaining high standards of cleanliness
in dental practices is important for three reasons:-
• Because it is what patients expect and deserve;
• Because it contributes to ensuring a safe environment for
care;
• Because it is a mandatory requirement under the Health and
Social Care Act
“Provide and maintain a clean and appropriate
environment in managed premises that facilitates
the prevention and control of infections.” (Health
and Social Care Act 2008 Code of Practice
criterion 2)

The essence of good cleaning is that things not only
look clean they ARE clean
Overall the environment should be clean, dry, well lit and
well ventilated.

Environmental Design
All surfaces should be such as to aid successful cleaning &
hygiene.
• Keep lines simple and clean without unnecessary ornamentation
(clutter)
• Wherever possible, surfaces (including walls) should be impervious,
continuous and free from damage and abrasion. They should be
free from dust and visible dirt.
• Notices should be laminated
• Surfaces, fixtures and fittings should be easily accessed for cleaning
• Modular furniture that is not easily moved should be on raised
platforms to achieve a 300mm clearance from the floor to allow for
cleaning

Environmental Design
• Work surfaces and floor coverings should be continuous, non-slip and
where possible jointless with coving to the wall
• All surfaces should be free from open joints and crevices that will retain dirt
particles. Unavoidable joints should be sealed with silicone
• Floors or walls penetrating pipes / ducts should be sealed tightly to prevent
entry of pests
• Wood, unsealed joints and tiles should be avoided as these may produce
reservoirs for infectious agents
• Ensure good ventilation
• Provide adequate hand washing facilities
• Provide adequate storage facilities that are easily emptied and cleaned
• Avoid open shelving and open storage
• Keyboards in clinical areas should be washable or have washable covers

The Revised Healthcare Cleaning Manual is primarily aimed at the
hospital sector although much of what it includes can be applied to other
healthcare environments and Dental practices may find it a helpful source
of advice and guidance.
The National Specifications for Cleanliness are designed to help providers
to meet the requirements of the CQC in relation to providing a clean and
safe environment for the delivery of care.
They will help to develop a system to assess the risk of’ infection and to
‘maintain appropriate standards of cleanliness and hygiene’
http://www.nrls.npsa.nhs.uk/resources/patient-safetytopics/environment/

Policy
• Identify Roles and responsibilities within the practice
• Outline standards to be achieved
• Detail procedure for risk assessment – identification of frequencies
based on local risks
• Detail provision, care & cleaning and storage of cleaning equipment.
– detail on colour coding
• Detail products used, correct use (dilution) storage and disposal
• Develop Schedules to demonstrate all areas of the practice are
cleaned in line with local risk assessment, who is responsible and
what products and equipment are used
• Detail Monitoring process & procedure for rectifying identified
shortfalls or problems
• Detail provision of training for staff and records to be kept

The Specifications adopt a 6 stage approach
consisting of:-
• Cleaning Plan
• Risk assessment
• Standard setting
• Frequency identification
• Cleaning responsibility
• Audit

“The Environment”
• All rooms : kitchen, staff rooms, store rooms, dental surgeries;
Reception & waiting areas
• Any general horizontal surfaces (low and high level) – floors, walls,
ceiling, worktops, shelving, skirting, window ledges
• furniture such as tables and chairs, toys
• Toilets, sinks and the items surrounding these, including, e.g. soap
& paper towel dispensers, waste bins
• Doors, door handles particularly those in the immediate
environment
• Light fittings and switches, radiators
• Window fittings i.e. blinds
• Kitchen equipment, fridge, microwave, cupboards

Risk Assessment - Areas
High-risk functional areas
Surgeries
Decontamination facilities
Medium / Significant Risk functional areas
public thoroughfares; waiting room
public toilets
Low-risk functional areas
Administrative areas, store rooms

Risk Assessment -Elements
Low risk items / surfaces
Patients and the public have little or no direct contact -
unlikely to act as reservoirs of infection (may include e.g.
mirrors, internal glass, fridges, microwaves).
Medium risk items / surfaces
Patients and the public normally have a moderate degree of
direct contact - unlikely to act as reservoirs of infection (may
include e.g. high and low surfaces, chairs, curtains).
High Risk items / surfaces
Patients and the public have extensive and frequent contact
- certain to act as reservoirs of infection (may include e.g.
toilets, medical & dental equipment used in patient care).

Cleaning Frequencies
• Cleaning frequencies are dependent upon degree of risk
attached to each item in its location and taking into
account what is practicable and necessary to ensure the
determined standard of cleanliness is being met
• Surfaces, fixtures and fittings in low risk areas are
cleaned less frequently than those in high risk areas,
however certain items are high risk regardless of the
area they are located and frequent cleaning is advised

Responsibilities
• Evidence from elsewhere suggests that it is crucial that
there be no ambiguity about whose responsibility it is to
clean areas/items.
• Providers are therefore recommended to ensure that
there is a clear framework setting out cleaning
responsibility for everything which needs to be cleaned
• In the majority of dental practices cleaning is undertaken
by dedicated cleaners with additional cleaning
responsibilities for nurses

Standard to be achieved
This may be a generic standard :
All parts should be visibly clean, with no blood or
body substances, dust, dirt, debris, spillages or
adhesive tapes.
or it may be more specific to the item in question.

Schedules
Schedules should demonstrate:
That all areas of the practice are cleaned including all elements
Frequency of cleaning for each area / element
What Equipment and products are used
Who is responsible
The standard to be achieved
Keep schedules with cleaning policy and display in each functional area

Training
• Staff should be trained at induction and updated annually
(or sooner if competency issues arise)
• Training should cover techniques (NHS Cleaning
Manual) use of products and equipment, Infection
Control and Health and Safety (manual handling,
COSHH, PPE, Hand Hygiene, Waste Disposal, spillage
procedures)
• Records of training should be kept in the practice

Monitoring
A key component of any system is having arrangements in place to
assess the effectiveness of the cleaning service.
Regular audits should be undertaken, problems identified are
recorded and actions taken to address discrepancies
Frequency of audits will be dependent upon risks – high risk areas
should be audited more frequently than lower risk areas
Issues raised should be followed up according to their magnitude and
location
Responsibilities given to managers, leads, supervisors who are
competent to judge what is an acceptable standard of cleanliness

CRITERIA
YES
NO
COMMENTS
Is the overall appearance of the clinical environment clean, tidy and uncluttered
Is the dental chair free from rips / tears
Are all surfaces i.e. walls, floors, ceilings, doors, fixtures and fittings and chairs free from dust and visible dirt
Work surfaces clean and free from damage
Floor Clean and free from damage
Are clinical areas free from free standing or ceiling mounted fans
Are window fitments (ie blinds) clean
Cleaning schedule on display
Checklist up to date
Is cleaning equipment stored correctly;
Stored out of clinical area
Buckets inverted and dry
Mops stored upright to dry
Single use covers changed after every patient
Are all surfaces and equipment cleaned in between patients; work surfaces, dental chair, dental light, bracket table,
delivery units, spittoons, x-ray heads, external surface of aspirator and curing lamp
Are all taps, drainage points, splash backs, sinks & spittoons clean and free from visible dirt
Are cupboard doors and accessible high level surfaces in clinical areas clean and free from visible dirt
Are radiators, shelving, inside cupboards and drawers clean and free from visible dirt

Cleaning
• Cleaning is defined as the removal of accumulated deposits by
washing with a neutral cleaning detergent and with thorough drying.
This will reduce the numbers of organisms and remove dirt, grease and
organic matter to an acceptable level.
• Cleaning the environment & equipment is important and particular
attention should be paid to horizontal areas and ledges where dust will
gather.
• Good quality disposable detergent wipes or neutral detergent, warm
water and disposable colour coded cloths should be used for cleaning.

What about Disinfection
• Microbes die rapidly on clean, dry surfaces, there is little advantage in
the routine use of chemical disinfectants, which may kill harmless
germs and allow those most likely to cause problems to flourish without
opposition.
• Disinfectants can have a harmful effect on the environment by
damaging the surface of equipment making it difficult to clean
effectively.
• Items in contact with mucous membranes or items that are
contaminated with virulent or readily transmitted pathogens or
substance i.e. saliva, blood etc. will require disinfection following
cleaning
• For surfaces which become contaminated with blood and other body
fluids a disinfectant solution of 1000ppm available chlorine should be
applied

General Principles of Cleaning
• Select the correct colour-coded equipment
• Wear appropriate personal protective equipment
• Use correct product diluted to manufacturers instructions
• Use correct technique paying attention to contact points
• Comply with H&S and infection control policies
– Hand hygiene
– Waste
– Manual handling
– Electrical equipment
– COSHH
– Spillage procedures

Surgery Hygiene
In addition to daily cleaning all areas which may become contaminated
during operative procedures should be cleaned in between patients:
• Local work surfaces
• Dental chair
• Inspection light and handles
• Delivery units / dental cart
• Spittoon
• Aspirator
• X-ray unit & Curing lamp if used
In addition, all surfaces that have potentially become contaminated
should be cleaned after each patient i.e. keyboards, drawer handles

Surgery Hygiene
• Clean and dirty areas for the surgery should be clearly identified to
reduce the risk of cross contamination.
• Keep surfaces clear and avoid open shelving and storage to reduce
risk of contamination with aerosols
• Areas local to the dental chair could be contaminated with aerosol
from 3 in 1, handpiece, scaler and disinfection of surfaces followed
by cleaning is advised
• Alcohol should be avoided as it binds blood and protein to stainless
steel
• Disposable covers can be used on light handles, chair controls,
switches etc and should be changed after every patient
• Appropriate use of gloves and adequate hand hygiene

Equipment
• Different areas should have different equipment
• Stored in dedicated area away from potential sources of
contamination and out of clinical areas
• Empty contents of bucket into dedicated sluice, outside drain or
toilet – NOT sink
• Buckets cleaned with warm water and detergent and dried after use
and stored inverted
• Mops stored head up and replaced or laundered weekly or sooner if
visibly contaminated with bodily fluids
• Cloths should be non-shedding and single use
• Hoovers should contain HEPA filters. Attachment tools cleaned with
detergent and warm water or detergent wipe

Download :- www.nrls.npsa.nhs.uk/cleaningspecificationsprimarycare

DEVELOP A SCHEDULE FOR A DENTAL
SURGERY
• What risk is this area
• What colour coding is used in this area
• List all elements within the area
• Determine frequency for each element (dependent upon
risk)
• Decide who is responsible

REFERENCES
The Health and Social Care Act 2008; Code of Practice on the prevention and control
of infections and related guidance - Department of Health (December 2010)
Health Building Note 00-09 – Infection Control in the Built Environment - Department
of Health (consultation draft April 2010)
HTM01-05 – Decontamination in Primary Care Dental Practices - Department of
Health (April 2009)
The Revised Healthcare Cleaning Manual - National Patient Safety Agency (NPSA)
June 2009
The National Specifications for Cleanliness in the NHS; guidance on setting and
measuring performance outcomes in primary care medical and dental premises –
NPSA (August 2010)

Any Questions