Hard surfaces in the surgery, e.g. work tops, equipment and containers, may become indirectly contaminated before, during and after treatment episodes with blood, saliva, oral and other bacteria or viruses. Therefore, staff must reduce the risk this poses by thorough cleaning of these hard surfaces between patients.
The treatment episode carried out for each patient should be risk assessed to decide the level of surface cleaning required. For example, surfaces will be contaminated up to a 1 metre radius if rotary instruments have been used on a patient, whereas an examination only will not create significant aerosol risk. Routes of contamination to be considered at all times include:
- Airborne particles following use of rotary instruments (aerosol)
- Splatter during surgical procedures
- Droplets from coughs and sneezes
- Touching surfaces and objects with contaminated hands
Safe Management of Care Environment and Safe Management of Blood and Body Fluid Spillages are two of the Standard Infection Control Precautions (SICPs) described in NHS National Services Scotland’s National Infection Prevention and Control Manual. Chapter 1 of this manual provides further guidance on cleaning of the care environment and the management of blood and other body fluid spillages.
Put together a written policy for environmental cleaning and ensure that staff are aware of this policy and related procedures (see Cleaning of the care environment and care equipment policy template).
Keep all surfaces in the surgery as clear and clutter free as possible to give easy access for cleaning; keep as many items as possible in cupboards or covered.
Check all surfaces are intact and if not have them repaired as soon as possible.
Ensure areas are clearly zoned and defined as clean or dirty.
Clean all large surfaces including clean and dirty zones at the beginning and end of a session using warm water and detergent.
Risk assess the level of surface cleaning required between treatment episodes:
- Low risk procedures (e.g. examination only), where surfaces are in the clinical area but not touched: clean surfaces using detergent wipes between patients.
- High risk procedures where aerosols are produced (e.g. surgical procedures, fillings), OR surfaces are touched (e.g. bracket table, light handles) or used for putting contaminated instruments or equipment down during ANY procedure: clean surfaces using detergent wipes followed by disinfectant wipes (if required) between patients, or use combination wipes if compatible. Do not clean the chair with alcohol wipes.
- Blood spillage: gather all appropriate equipment; perform appropriate hand hygiene; wear appropriate PPE. Apply chlorine-releasing granules directly to the spill. Alternatively, contain the spillage with disposable paper towels; saturate the towels with disinfectant solution (with a concentration of 10,000ppm available chlorine) and leave in place as recommended in the manufacturers’ instructions, or for at least 3 minutes; dispose of towels as healthcare waste. Clean the area with fresh disposable towels and a solution of water and general purpose neutral detergent; and follow with appropriate hand hygiene.
Refer to the Safe Management of Blood and Body Fluids Spillages SICP for how to deal with other body fluid spillages (e.g. urine, vomit).
Have in place a schedule and instructions for the cleaning of non-clinical areas of the practice (e.g. the waiting room, patients’ toilets – see Cleaning Schedule and Records template).